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23  WEST  MAIN  STREET 

WEBSTER,  N.Y.  14580 

(716)  872-4503 


-«6" 


CIHM/ICMH 

Microfiche 

Series. 


CIHM/ICIVIH 
Collection  de 
microfiches. 


Canadian  Institute  for  Historical  Microreproductions  /  Institut  Canadian  de  microreproductions  historiques 


O^ 


^ 


■ 


Technical  and  Bibliographic  Notns/Notes  techniques  et  bioiiographiques 


The  Institute  has  attempted  to  obtain  the  best 
original  copy  available  for  filming.  Features  of  this 
copy  which  may  be  bibliographically  unique, 
which  may  alter  any  of  the  images  in  the 
reproduction,  or  which  may  significantly  change 
the  usual  method  of  filming,  are  checked  below. 


0 


y/ 


n 

a 


D 


Coloured  covers/ 
Couverture  de  couleur 

Covers  damaged/ 
Couverture  endommagde 

Covers  restored  and/or  laminated/ 
Couverture  restaurde  et/ou  peiliculie 

Cover  title  missing/ 

Le  titre  de  couverture  manque 

Coloured  maps/ 

Cartes  g^ographiques  an  couleur 

Coloured  ink  (i.e.  other  than  blue  or  black)/ 
Encre  de  couleur  (i.e.  autre  que  bieue  ou  noire) 

Coloured  plates  and/or  illustrations/ 
Planches  et/ou  illustrations  en  couleur 

Bound  with  other  material/ 
Reli4  avec  d'autres  documents 

Tight  binding  may  cause  shadows  or  distortion 
along  interior  margin/ 

La  re  liure  serree  peut  causer  de  I'ombre  ou  de  la 
distorsion  le  long  de  la  marge  int^rieura 

Blant.  leaves  added  during  restoration  may 
appear  within  the  text.  Whenever  possible,  these 
have  been  omitted  from  filming/ 
11  se  peut  que  sertaines  pages  blanches  ajouties 
lors  dune  restauration  apparaissent  dans  le  texte. 
mais,  lorsque  ceia  dtait  possible,  ces  pages  n'ont 
pas  iti  filmies. 


L'Institut  a  microfilm*  le  meilleur  exemplaire 
qu'il  lui  a  iti  possible  de  se  procurer.  Les  details 
de  cet  exemplaire  qui  sont  peut-dtre  uniques  du 
point  de  vue  bibliographique,  qui  peuvent  modifier 
une  image  reproduite.  ou  qui  pe-jvent  exiger  une 
modification  dans  la  m^thode  normale  de  filmage 
sont  indiquis  ci-dessous. 


n  ? 


Coloured  pages/ 
Pages  de  couleur 


n 


y 


D 


Pages  damaged/ 
Pages  endommag^es 

Pages  restored  and/or  laminated/ 
Pages  restaur^es  et/ou  pelliculdes 

Pages  discoloured,  stained  or  foxed/ 
Pages  ddcolordes,  tachet^es  ou  piquees 

Pages  detached/ 
Pages  ddtachees 


r~7|    Showthrough/ 


Transparence 


□    Quality  of  print  varies/ 
Quality  inigale  de  I'impression 

□    Inclucies  supplementary  material/ 
Comprend  du  materiel  supplemen 


The 
to  tl 


upplementaire 


I      I    Only  edition  available/ 


n 


Seule  Edition  disponible 

Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc.,  have  been  refilmed  to 
ensure  the  best  possible  image/ 
Les  pages  totalement  ou  partiellement 
obscurcies  pa*-  un  feuillet  d'errata.  une  pelure, 
etc.,  ont  it6  film^es  i  nouveau  de  facon  a 
obtenir  la  meilleure  image  possible. 


The 
posa 
of  th 
film! 


Orlgi 

begii 

the! 

sion, 

othe 

first 

sion, 

or  ilii 


The  I 
shall 
TiNU 
whici 

Maps 

differ 

entire 

begin 

right 

requii 

meth( 


D 


Additional  comments:/ 
Commentaires  supplimentaires; 


This  item  is  filmed  at  the  reductic  i  ratio  checked  below/ 
Ce  document  est  film*  au  taux  de  reduction  indiqu*  ci-dessous. 
^0^  . 14X  18X  22X 


12X 


16X 


TT 


20X 


26X 


30X 


24X 


28X 


] 


32X 


The  copy  filmed  here  has  been  reproduced  thanks 
to  the  generosity  of: 

La  Bibliothique  de  la  Villa  de  Montreal 


L'exemplaire  film«  fut  reproduit  grAce  A  la 
g6n4rocit6  de: 

La  Bibliothdque  de  la  Vllle  de  Montrtel 


The  images  appearing  here  are  the  best  quality 
possible  considering  the  condition  and  legibility 
of  the  original  copy  and  in  keeping  with  the 
filming  contract  specifications. 


Original  copies  in  printed  paper  covers  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  last  page  with  a  printed  or  illustrated  impres- 
sion, or  the  back  cover  when  appropriate.  All 
other  original  copies  are  filmed  be;j:roing  on  the 
first  page  with  a  printed  or  illustrated  impres- 
sion, and  ending  on  the  last  page  with  a  printed 
or  illustrated  impression. 


The  lust  recorded  frame  on  each  microfiche 
shall  contain  the  symbol  -h»-  (meaning  "CON- 
TINUED"), or  tha  symbol  T  (meaning  "END"), 
whichever  applies. 

Maps,  plates,  charts,  etc.,  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  are  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


Les  images  suivantes  ont  6t6  reproduites  avec  le 
plus  grand  soln,  compte  tenu  de  la  condition  et 
de  la  nettetd  de  l'exemplaire  filrn6,  et  en 
conformity  avec  les  conditions  du  contrat  de 
filmage. 

Les  exemplaires  originaux  dont  la  couverture  en 
papier  est  imprim6e  sont  filmds  en  commen^ant 
par  le  premier  plat  et  en  terminant  soit  par  la 
dernidre  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration,  soit  par  le  second 
plat,  selon  le  cas.  Tous  les  autres  exemplaires 
originaux  sont  film6s  en  commenpant  par  la 
premidre  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration  et  en  terminant  par 
la  dernidre  page  qui  comporte  une  telle 
empreinte. 

Un  des  symboles  suivants  apparaitra  sur  la 
dernidre  image  de  cheque  microfiche,  selon  le 
cas:  le  symoole  — ^  signifie  "A  SUIVRE  ",  le 
symbols  V  signifie  "FIN  ". 

Les  cartes,  planches,  tableaux,  etc.,  peuvent  §tre 
film6s  d  des  taux  de  reduction  diffdrents. 
Lorsque  le  document  est  trop  grand  pour  dtre 
reproduit  en  un  seul  clich6,  11  est  film6  d  partir 
de  I'angle  supdrieur  gauche,  de  gauche  d  droite, 
et  de  haut  en  bas,  en  prenant  le  nombre 
d'images  n^cessaire.  Les  diagrammes  suivants 
illustrent  la  m6thode. 


1 

2 

3 

12  3 

4  5  6 


^''^^0^^  >:!'Sm^^'<<.^  ^■^*^^   .        ;j. 


REPORT 


~\1 


01   THE 


^^msiisissQSf 


APPOINTED  BY  THE 


$AHITABir  BOARB  OF  THE  CIXY  C01JIVCI1.IS. 


I 


TO 


!#-: 


VISIT  CANADA, 


»oa  THE 


INVESTIGATION  OF  THE  EPIDEMIC  CHOLERA; 


ruTAiuirs  IS 


MOJTFREAL  AJrn  qVEBEC. 


■f  I     I  imnri  I 


PHILADELPHIA: 
PRINTED  BY  MIFFLIN  &  PARRY. 


Phileas&acnon, 

Qugeec.  Canada 


'^i^ppi^^pif 


■   M:        1-.      >? 


SA 


I 


^^ 


y 


;   \  I 


^CT  D 


REPORT 


or   TH?. 


(P^Silll^^S©!!? 


APPOIMTED  BY  THE 


SAmi  ARY  BOARD  OF  THE  CITY  COraCII^S. 


TO 


VISIT  CANADA, 


TOB  THE 


it;  7ESTIGATI0N  OF  THE  EPIDEMIC  CHOLERA, 


rnEVAiList*  i» 


MOJ^TREdL  A.YD  qUEBEC. 


PHILADELPHIA: 
PRINTED  BY  MIFFLIN  &  PARRY. 


1832. 


' 


Sanitary  Board,  June  22,  1832. 
"  Resolved,  That  it  is  expedient  that  three  physicians  of  emi- 
nence be  appointed  to  proceed  forthwith  to  Montreal  or  Quebec,  or 
both  at  their  discretion,  to  ascertain  the  true  character  of  the  dis- 
ease prevailing  there,  and  to  attain  such  further  information  in  re- 
lation thereto  as  they  may  deem  necessary,  and  to  make  their 
communication  as  early  as  practicable  to  this  Board. 

The  Board  appointed  Samuel  Jackson,  M.  D.,  Charles  D.  Meigs, 
M.  D.,  and  Richard  Harlan,  M.  D." 

Extract  from  the  minutes,  July  30,  1832. 

SAMUEL  DAVIS,  Secretary. 


I 


v^ 


^l! 


>:u^. 


.<-.  ■« 


*f'j 


ERRATA. 
Page    8,  line    5  from  botioin,/or  Mr.  Mann, 
"    21,  line    1  at  the  top,    /or  applied, 
"    23,  line  30  from  top,      for  spine 
"    27,  line    3  from  top,      J'jt  pressure, 


read  Mr.  Marcoe. 
read  apply. 
read  spice. 
read  presence. 


28,  line    9  from  top,      j'or  overpowering,  read  occupying. 


^     f^ 


BJ1^®31S< 


T,.„  commiMion  appointed  to  proceed  '<>  Canada,  wUh  the  oj 

'"mih\Ve:  Cesent  their  observations  in  a  clearer  manner 
anymore  Sensc'd  form,  they  have  been  divided  uUo  two  parts, 
and  the  subject  arranged  under  distmct  heads. 

Part  isi.  Historieal  riew  of  the  commencement  and  progress 
qfthe  Epidemic,  and  attending  circumstances. 

I.  The  commencement  and  spread  of  the  disease. 

The  first  cases  of  Cholera,  appeared  -l'"^?*  simultaneously  .i 
Quebec  and  Montreal,  distant  from  each  "^.^er  IBO  rmles.  m 
Quebec,  the  disease  was  manifested  on  the  8lh  June,  ^-^  M°"*^«2 
the  first  case  was  on  the  9th,  when  an  emigrant  ^««^^"f  ^  '^^ 
The  Steamer  Voyageur,  who  had  bee"  taken  s.^k  -    he^p^^^^^^^^^ 

up.     The  first  cases  «t  Q'^tou^e^k  p?  bv  1  mTn  named  Roach, 
plain  street,  in  a  boarduig  house,  kept  by^m  ^^^^^  ^^^ 

The  patients  were  emigrants.     Th«y  Ijad  em^arKe^ 

Steamer  Voyageur  to  proceed  to   Montreal.  ^^  ^^^^^^b 

°^"'°tirclti:n"etu?d  xTs^r^^^^ 

£mo   tfrirung-r^able,  a^^^ 

toQuebec,  wlfiich  the  bout  reached  in  the  n^^^^^^^^  l7aT   xcitement 

S-vicTit"of  m^f  S  Cholera    ^AUhe  «same  Ume  a  C  na^^^^^^ 

Sllnc'treTtta^k^'r.fitrthrdtsLt^'^  be  ascer- 

a  ned  Te  eiSgrants  first  attacked,  after  the  exposure  and  excite- 

passengers.     ?"^b.  voyage,  thirty  n  ^^^  ^^^  ^^. 

in  Quebec.     The  passengers  were  landed,  ^"^  f^^  f  ^ioke  o*t 


.M"-.:-t»».^  f- 


i'^rmf^' 


and  Mr.  Voung  the  Secretary  of  the  Board  of  Health,  visited 
Grosst;  Isle,  on  the  7th  of  June,  examined  the  passengers  and 
crew,  and  reported  that  no  case  of  Asiatic  Cholera  was  on  the 
iaisnd.  Tiiis  fact  was  annou.iced  by  the  Hoard  of  Ilaalth  to  the 
public  on  tiio  8li)  of  June,  to  quiet  the  aj)piTlien.sion'«  of  liie  citi- 
zens of  Quebec,  cxciteu  by  reports  of  a  vessel  having  arrived  at 
Grosse  Isle  with  cases  of  the  disease  on  board.  Thus  it  appears 
that  the  crew  and  passengers  of  the  Carricks,  the  only  vessel  on 
board  of  which  cases  of  Cholera  had  appeared,  were,  on  the  Sth  of 
June,  the  day  the  disease  commenced,  detained  at  Grosse  Isle  un- 
der quarantine,  having  had  no  communication  with  Quebec — and 
at  the  very  moment  the  proclamation  of  the  Board  of  Health  an- 
nounced to  the  public  that  the  Carricks,  her  crew,  and  passengers 
were  in  quarantine  at  Grosse  Isle,  and  that  they  were  exempt  from 
Cholera,  the  disease  had  then  broken  out  in  the  city  itself. 

The  disease  having  made  its  inroad  in  the  manner  described,  did 
not  extend  slowly  from  the  point  of  its  first  onset,  but  manifested  it- 
self in  almost  every  part  of  the  town,  proceeding  with  rapid  strides 
to  every  quarter.  From  Friday  evening,  the  Sth  of  June,  to  Tues- 
day morning,  at  9  o'clock,  12th  of  June,  little  more  than  three 
days,  70  deaths  had  taken  place,  from  every  point  of  the  city.  By 
this  time,  also,  the  disease  had  shown  itself  at  Point  Levi,  on  the 
opposite  shore  of  the  St.  Lawrenco,  at  Beauport,  and  Little  River. 
The  first  case  in  Montreal  was  r.n  emigrant  who  was  landed  on 
tiie  9th  of  June  from  the  Voyageur  steamer,  as  has  been  already 
mentioned,  and  died  the  aame  night,  near  the  old  market  house. 
The  next  day,  the  10th  of  June,  a  number  of  cases  appeared  in  the 
St.  Lawrence  suburbs,  particularly  in  Sanguinette  street,  distant 
from  the  old  market  house  about  half  a  mile.  Cholera  cases  imme- 
diately sprang  up  in  great  numbers  in  numerous  uni^onnccted 
points.  The  quarters  of  the  town  in  which  these  chiefly  occurred 
were  the  St.  Lawrence  suburbs,  back  of  the  town,  the  Quebec 
suburbs,  north  of  the  town,  and  the  St.  Louis  suburbs,  between 
the  two  last.  But  very  few  cases  were  developed  in  the  city,  and 
especially  in  the  streeta  immediately  adjacent  to  the  river,  or  on 
the  river  bank,  where  the  emigrants  were  bivouacked,  barely  pro- 
tected from  the  weather  by  pieces  of  scantling,  sustaining  old  blan- 
kets, rugs,  or  similar  materials. 

It  is  here  to  be  remarked,  that  the  first  spread  of  the  disease,  its 
irruption  upon  the  population  of  Montreal,  was  in  the  positions 
that  have  been  indicated.  The  city,  or  the  port,  properly  speak- 
ing, was  the  last  and  the  least  afiectcd. 

The  rapidity  with  which  the  disease  advanced  in  Montreal  and 
the  suburbs,  is  almost  unexampled  in  the  annals  of  pestilence.  Its 
commencement  may  be  dated  properly  the  10th  of  June.  As  late 
as  the  12th,  the  existence  of  Asiatic  Cholera  in  the  city  was  denied 
in  the  papers,  and  the  rumour  treated  with  disdain.  On  the  13th 
the  Board  of  Health  announced  the  prevalence  of  the  disease,  and 
ikxied  their  first  report.  The  number  of  cases  for  the  last  twenty- 
four  hours  was  stated  at  94— the  deaths  23.    On  the  15th  they  re 


\J^ 


Jiod  wheu  the  a.sease  first  «PP««;«^;  ^'^^^,,J  ^^t  be  ascertained. 
Te  exact  number  of  casesand  r^^^^'J^^^^  fining  in  the  m.dst  o 
This  .nnunciafon  was  hkc  ^  ^" " ^d  „    storm      Dismay  so.zed 
a  population,  unconscious  ^f/^"  '^^^.^fed  the  city,  which  doubt- 
on  eW  mind.  A  un'V"«=^\P\° '/^'Jf^^^^^^ 
less  contributed  ^othe  augmentatu,r^of  the  ^^^^^ 

Ihe  Board  on  the  1 6th,  f  J*  ^^^J^f^^^y,,''  at  82;  and  for  the  sue- 
at  431,  and  the  deaths,  •'  ^^^^^''^'^^,^^'^^ooiX  475  new  cases  and 
ceeding  twenty-fcur  hours  ^hcr^mbcrs  stood  ^^^  ^^  ^ 

102  detths.  Taking  into  '^'f"  f  ^^^^^^^^^^^^^  a  scene  of  unpa- 

estimated  at  25,000  souls,  ^h  «     atej.ieni  ^^^^  ^^^^^^,^  ^f  ^^e 

ralleled  desolation:  «f!J«'";j,'^^,^f„Xsts  have  engaged,  »o  se- 
bloodiest  strifes,  in  which  contending 

vere  a  loss  of  human  Idc.  unsparingly  ravaged  by 

While  Quebec  and  ?»,^oj^;«^^\,^;"J,  "  e  was  not  enjoyed  by  the 

,he  pestilence,  immunity  ^^om  the  jcourg  ^.^rence,  not  by 

numerous  villages  that  '"f  ^^«  ^^^^^^^^^  it  extended  to  Kamouraska, 

the  adjacent  country.    Below  ^"^7^ !\^*^^^^^         atRiviere  Quel  e, 
a  distance  of  eighty  miles  from  the  city    tex^s^^^      ^^^ 

at  Bertha,  at  Point  I  evi,  ^fj^f'^^ll'^l^^  ^u  Tremble.,  and  Long 
it  prevailed  at  Lotl.mcre,  Ber  hitr,     omi  .^i^ience,  though 

Point.     These  are  places  ^*1^^^« J^n'f^ubiected  to  its  innuence. 
probably  many  others  ^«/f  Jfj.'fe  o^  Lawrence,  skirt- 

^bove  Montreal  It  pursued   h«  f  ""^^^  °j  „,ff,io.  We  witnessed  it 
ed  the  shores  of  Ontario,  and  had  reacuca  ^         ^^  Lachine, 

:?LaPrarie,  and  obtained  informaU^  Harlan  Cha- 

Caughnawagaa,anlnd.ansetlement  V  J^^^^     ^^    ^t,^ 

♦na.il^.nv    S^  Pegis,CoinwaH,4'resc9i.i,    g,  Lawrence 

wcrlthc  routes  of  U»toobnBmatch'',3_^,,i„atU^ 
entering  from  Ihe  '"V*"^  ;  111,  ianetion  with  the  St.  Law- 
tngChambly,  some  d''^'"""  ^^  "'„£Vtion  at  Plallsburgh,  on 
rence,  and  St.  Johns.  It  mode  »"/"''"  j„eloped,  but  soon  ter- 
Lake  Champlaln,  where  seven  ";=|  "^Xriioftton  and  Mont- 
„i„,ted;  am'  »""!Jf,d,.S  fft  Miller,  and  lle*anicsvlle, 
OorCrt":;'"H"^r;nLdoa,swh.a^ 

b^rnn^w^rifierstSJ:;:,  bin  communicated 

'°CGr».-.d  or  2^^-i^^f^C^^:^^ 
r."e:ct7cl'rfwa'rGr«(crar.d    By-to«n,   one  hundred 

■'■■'\^'^;::rorff«;ed^^^^^^^^ 

„any  --i''T''.,^°"^£l-„ecounts  of  Ae  disease  published  .nEu- 
rally  been  neglected  in  the  a"=°""'p.  ,  ^^  been  principally  the 
;„pj  and  Asia.  The  ^f  °"»?„t%r„?ty,  or  tlie^rmy  .ur^=™ 
£tr.:Virre"gt^;tn'd  hll  observation  have  been  restricted 


to  the  immediate  sphere  of  his  action.     It  was  a  subject,  conse- 
quently,  ot  interest  in  our  investigations,  and  it  is  one  of  reeret 
that  our  opportunities  did  not  admit  of  a  more  full  examination' 
A  sufficient  number  of  facts  have,  however,  been  ascertained,  to 
render  It  more  than  probafc  j,  that  the  disease  extends  its  ravages 
over  the  champaign  country,  as  well  as  the  densely  crowded  citv 
or  populous  village.     On  the  route  from  St.  Johns  to  La  Prairie 
the  position  where  we  entered   the  region  then  ravaged  by  the 
Cholera,  we  ascertained  the  existence  of  several  cases  of  the  disease 
actual  y  existmg  in  the  detached  farms  in  the  country.    It  vj  to  be 
remarked,  that  with  the  exception  of  a  single  case,  the  others  were 
unknown  to  the  physicians  residing  at  St.  Johns,  distant  but  a  few 
miles    From  the  rapid  course  of  the  disease,  the  inhabitants  thought 
It  useless  to  send  to  the  town  for  medical  assistance.  Dr.  Buckley 
ot  St.  Johns,  mentioned  that  the  priest  of  the  Parish  of  St  Luke' 
had  informed  him  of  two  fatal  cases  of  the  disease,  in  persons  residing 
three  miles  back  from  the  main  road,  and  who  had  had  no  communi- 
cation with  the  sick.     In  the  Parish  of  L'Acadie,  to  the  south-west 
01  the  road,  we  were  informed  that  numerous  cases  had  occurred 
and  we  subsequently  learnt  that  in  the  seigneurie  of  St.  George' 
ten  miles  below  La  Prairie,  a  number  of  individuals  had  died  of 
Cholera.   Ai  the  Tanneries  de  Roland,  above  Montreal,  and  at  the 
Cote  des  N.eges,  back  of  the  mountain,  several  cases  had  also  oc- 
curred,  and  some  deaths.    Along  the  Richelieu,  between  Chambly 
and  M.  Johns,  some  cases  were  also  developed  in  the  small  farms 
that  line  its  banks. 

From  this  general  sketch  of  the  extent  of  country  invaded  by  the 
disease,  at  the  period  of  our  visit  to  Montreal,  its  rate  of  nrogres 
sion  exh.^iits  a  rapidity  far  exceeding  any  former  instance  of  the 
kind  in  IS  history  From  the  8th  of  June,  the  day  of  its  irrupt  on 
nto  Quebec,  to  the  28th  of  the  same  month,  a  period  of  only 
twenty  days,  it  extended  along  the  course  of  the  St.  Lawrence  a 
distance  of  from  six  to  seven  hundred  miles,  besides  extending  up 

it  ?o"L:L°ciarptrn.'  ^"'  ""^  ^'^"^'^^  '''''^^^  -^^  ^^^^-^^ ' 

In  connexion  with  this  extraordinary  fact,  should  be  taken  into 
consideration,   the  imniense   body  of  emigrants  who  had  lately 

nil  f  ^"If '''  '"'^  ^^°'   ^y  '^''  ^^-^"'-boats,  were  rap  d  y 
spread  along  the  very  route  we  have  indicated  as  pursued  by  the 
disease.     It  appeared   to  flow  along  with  the  tid'e  of  emigration 
The  following  report  exhibits  the  number  of  emigrants  landed  ai 

T  '^°*?'f"'?ber  of  emigrants  arrived  from  2d  of  June  to  23d  of 
June,  both  days  inclusive. 

Last  week— Males g^j 

Females gj^. 

Children yyj 

Previously  reported       .        .         .        .        .  j|oi6 


XL 


i 


30,494 


The  following  statement  show,  the  number  of  emigrant,  that 

arrived  at  Montreal. 

T.,ne7   arrived  in  Steamer  John  Bull      - 
June  7,  arnv     ^^  ^^^^^  ^^^  ^^^^^^^  ^^  ^^^ 

In  Steamer  British  America 
Chambly 
Lady  of  the  Lake 


Cabin. 
32 

9 
23 


64 
18 
25 


Steerage. 
1150 
375 
630 
530 
240 

2925 
882 
740 
230 

4777 
550 
644 
218 
794 
114 

7097 


Arrrivals  on  the  7th  of  June    -        -        " 
LeB,  arrived  in  steamer  J^..™Mo1.o„_ 

Lady  Aylmer 

1.07 

Time  9  to  12,  arrived  in  Steamer  Voyageur         37 
juney  lo  »*>  •»•  g^.  Lawrence    22 

Lady  of  the  Lake  7 

Chambly  15 

British  America  23 

211 

Total  from  June  7  to  June  12        -        " 

The  emigrants  ^r^S:^;::^^^ZX^^^^ 
of  their  destination    Some  penetrate  m  ^^  ^^ 

La  Prairie    St   Johns   and  L^e  Champ       ,^^^  ^^^^^^^^  ^^^^^^ 
and   New   Y°rk   cluefly  by  Weh^^^  .^  ^^^  ^^^^^^^^^ 

Others  ascend  the  P"^\^'^°M,_„t„r  numbers  pursue  the  course 
forming  on  its  banH-whiestigre^^^^^^^^^^  ^^^^  ^,^^ 

of  the  St.  Lawrence  to  the  laKes,  aim    i 

adjacent  country. 

„    ne  Character  of  tkeFopulation.^f  Us  relation  to  the 
"•  Epidemic  Influence. 

^  r      r.f  Qnphec  and  Montreal  is  of  a  mixed  charac- 

The  population  o^^^rp.  manners  and  modes  of  life.    At  the 

ter,  and  possessed  oj^ditont^^^^^^^^^^^^    ,f  emigrants  principally 

period  of  the  epidemic  uwaF  ^         residents  from 

bV^l^^^  clSro? French  origin;  and  of  English 

-^T^ttiy  arrived  e^-i.-^t  Q^^^^^^ 

of  the  disease,  ^^\\'fl'^'''t^^  ^^.^er^i  population  of  Quebec 
Sre?trb:27:000rand  th?tTMW^5%0.  The  larger 
proportion  consists  of  Canadian  French. 

P  Quebec  and  Montreal  ^^^^'^^'^^^^^^^ 
flood  of  emigration.  No  adequate  po^^^^^^^^^  ^^^^^^^  ^^^^ 

per  accommodation  to  the  host  that,  lor  ^  ^^^^^tg  of 

ing  from  the  ocean,  swarm  on  the  quays,  wnaivc  , 


I 


6 

ya^.t:^.„?:^,„7w^^^  -  i"-ventilated 

By  Dr.  Robinson,  of  Mon";eaI  wp  L  ''""  ^''°^^  ^^e  weather, 
usual  for  «ix  and  ^ven  en  fam  'lil  to T  '"^°'''"''''  ^^  ^^^«  "°t  un- 
inhabited by  one.    In  ahorZl!-    '""^^^  ^  tenement  formerly 

sick  with  typhus  fever.  So  deVtihup'  *^T^^"  °^ ^^om  werl 
and  so  little  capable  of  procuHnL  hV?  """^'''  °^  ''^^^^  P^°P'^» 
arge  wooden  sheds  have^bSTrfcted  to  Tr?^'  lodging^s,  thai 
shelter.  At  Montreal,  the  Board  of  R  uf^'i  ^^^'^  ^  temporary 
fenced  its  ravage.,  tiok  poss  sion  S  tt  '  \^'?  '^'  '^'''''^  ''^- 
\hem  into  hospitals.  Lario  n„mL  c  ?^^  '^^''«'  «"d  converted 
quenily  forcecfto  bivou  cTonTheT/ ''"'  '"T^"^^  ^^^''^  «°"«e- 
banks,  exposed  to  every  vicissitude  n^fH  ^'"""l'  ''°"g  ^^e  river 

of  the  vessels  i^ltrttrfgS  ^^^^^^  «tate 

•ages,  averaging  from  fifty  to  sixtv  davs  fvf"  .'^^.^^"8^^  of  the  pas- 
tating  food  and  bad  water^to  wS  thlt'l  "l^'S^^tible  and  irri- 
accustomed,  together  with  thrinfluel?,  7'  ^''"  Previously  un- 
tute  a  combination  of  causes  hi Jhlvn'?  "^  "•  ""^  ^'''"^te,  consti- 
tacks  and  ravages  of  disease      ^^P'^'^'^P^^'^g  ^^em  to  the  at- 

the^o'roTtKidreTtatV':^!^"^  ^"^''^^^^^  -«  ^-ted  to 
It  was  then  observed,  LvafablvL'"'"'''"'^^^''^^^ '"^^ 
gastro-enteritic  fever  ,w'htvnh5?r  °"^'"  '°  ""'"^''^^^  '^ases  of 
and  German  passenge  sr   '  hfper  odr^H°";f'  %"^°"g^^  '^'  ^''-h 
The  wards  of  the  Alms  Hm,«!  rT      "'^  shortly  after  their  arrival 
crowded  with  patfenTs  of  thl  "f '"'7  ""''''  ''  ^^at  time,  often 
brought  in  labouring    nder  th     forn  ';•     "^^'^^  ^'""'^'^«  ^^'e 
cas.ons  it  was  necesfary  to  de  'jn  th.  i^''?'"'  ^"^  °"  '^^^  oc- 

sengers  into  the  Lazare^tto  Ho  pi"a     Lr?!    '  '"^'""'^   ^'^^  P^^" 
board.  "  "ospudi,  irom  the  number  of  sick  on 

ofNt?srt"^an;rSB,::fn?^^  '/^'"^/-^  ^-^^  the  direction 
flicted  the  emigran^,Tnd  oecJioL^''''''  ''''  ''""'  ^'«^»«^  al- 
most lamentable'mortality  Wfthin  L  1-?^'  '^''^'  ''  '^'^'''  ^ 
changed  ,ts  direction,  and  now  rolls  with  \  ^''''  '^  ^''  «g«'" 

the  m.ghty  stream  of  the  St  Lwrence  to  "r''  ^"^.'"^"tation^p 
of  Canada,  or  thickening  the  SmenN  n?  '."^"P'^^^^  '^^  ^''d« 
of  our  country.  The  simP  nff!ni  T  "  °^  ''^^  western  districts 
of  the  same  effects,  ndTreat„"^^^^^  circumstances  are  product  ve 
struck  down  with  feversTf  tvZ  d?  "'  ^"'^^  ''"^  Montreal  are 
"h.     The  following  sLllS^K-  T'  ""'^"''  ^^ich  many  per- 

^trate  the  correctness  onh'rremarT"'^^  ^'"  ^^"'o- 

Pital   frl-^Nt"^^^^^^^^^^  General  Ho. 

;his  had  been  the  average  for  rvVr.l     '"''''  if.^^'  ^^'^  ^52,  and 
November  1st,  1830,  to  Apri    ist   Lj^T'''    ^^'  admissiousVrom 

missions  from  November  1st   i83i   to  A   Tf '^''  ""'^  '^^  »d- 

ist,  1831,  to  April  1st,  1832,  were  565. 


'The  typhus  fever  f  i^J-t'^b.ltl'r-tS^t^e; 

The  emigrants  newly  ^"^Yf^'/V'V.se   fnj   r"'"  ^eing  thus  an 
strongly  predisposed  to  attacks^^^^^^^^  J^^^  ,he 

-fere..ch  Canadian^,  unde^--^^^^ 

habits,  religion,  ^^  'nodes  of  h  e,smce  ine  c     4^  ^  ^^^ 

by  the  English.    He  ^^^tams  all  the  pecuuar  ^^^  ^^^^^^^ 

Manifests  in  every  respect  J'^J^'^^hf  on  ^alteration  attendant  on 
of  the  nation  ^vhence  he  sprung    The  ^^^y^^^^  ^^^  ^^^^  ,^ 

that  event,  has  been  in  the  rulers,  d»  , 

government.  .    .      ,       ^  Canadians  is  vegetables,  with 

The  general  .^'^^^  ^f^j^^;  ^^^1  ttle  attention  to  comfort  or  clean- 

re'srat\T:r;tTin\;4erate.     The  liquor  in  most  common 

"^^1^ ;^:^e  the  usual^^ton.  of  th^r  c^^,  and 
use  a  ffood  substantial  nutriment,  ^'^hte  attention 
Z:!i  life  for  which  their  nat^^^^^^^^^^^^^ 

The  epidemic,  on  its  first  «PPf  ^^'^f^he  same  moment.  At  Que- 

French  Canadian  P?P"^\^°";f^"^°1  Voyageur,  under  the  circum- 
bec,  the  emigrants  landed  i^rom  the  Voyag^^^  ^^ 

stances  already  detailed,  and  ^"^JPjT^^^t  ^n  the  same  and  the 
of  the  disease,  were  the  ^'f.;''^'^',^^^^^^^^  AtQue- 

next  day,  the  French  Canadians  were  eHuaiy  .^  ^^^ 

bee,  ^rom  the  great  number  ^^ J^^f'^^J^'^^t^^.^d  j^nesV  the  lower 
small  tenements  and  narrow  confined  st'reets  an  ^^^ 

town,  a  larger  proportion  of  ^heni,  >t »«  ^aiU,  wer 
perished,  than  of  the  residents  ^"^  «aj  ^^^^j^        j.  The  emigrants 
^  In  Montreal  this  observation  d'd  not  hom  goo  ^^^^J>^^^  is 

suffered  less  than  other  classes  o   the  popu^t'on    1  he  tol  ^^  ^  g  ^^ 
an  extract  taken   rom  the  Montreal  G^^etteot  ^ 

«  Another  fact  which  cannot  fail  to  strike  every  ^ 

i,  thatbutaverysn;allpr.por^-^^^^^  4h  shi/- 

arrived  emigrants,  oi  those  conneu.  greenest  seve- 

ping,  but  the  disease  «eems  to  have  fallen  wunig^^^^^  .^ 

•it/ on  the  natives  of,  or  those  who  hf^f/aL  paper,  is  the  fol- 

Jcountry."    Ontlie  l«t^^.  °f .J""^'/"  t^seTaS 

lowing  remark :  "  The  prcjudi  e  that  has  ^^sen  «|  ^^^  J^^ 

arrived  emigrants  is  most  "«f°"»t';^'/°l^'J',"  long  time  resident 
^The  En^gtS^^^  of  the  population  of  Montreal  escaped  ^edi. 
others. 


I 


8 

At  La  Prairie,  the  individuals  who  first  experienced  the  pesti- 
lential influence,  were  the  carters  of  the  town,  who,  like  the  rest 
of  the  lov/er  Canadians,  are  habitual  consumers  of  ardent  spirits 

The  first  individual  living  in  St.  Johns,  attacked  with  the  dis- 
ease, was  a  native  Canadian,  of  the  name  of  Telron.  «  He  had  not 
been  without  the  limits  of  the  town  for  perhaps  years,  an  J  had 
had  no  intercourse  whatever  with  emigrants,  faither  than  teeing 
them  pass  the  streets."*  His  habits  were  intemperate.  He  died 
after  an  illness  of  15  hours.  He  was  attacked  on  the  14th  June- 
on  the  15th,  his  daughter  suffered  a  slight  attack;  on  the  18th  the 
widow  was  taken  down,  and  though  she  recovered  from  the  first 
symptoms,  subsequently  succumbed  under  those  of  a  typhoid  tvoe 
Ihree  other  members  of  this  family  experienced  the  disease,  but 
in  a  mitigated  form.  ' 

A  case  had  previously  occurred  on  the  11th  of  June,  in  an  Irish 
woman,  an  emigrant,  in  the  vicinity  of  St.  John's.  She  had  le''t 
Montreal  that  morning  in  good  health,  was  seized  on  the  road,  7 
miles  distant  from  St.  Johns,  with  violent  spasms  of  the  extremities 
and  abdomen,  and  died  the  next  day,  soon  after  she  had  been 
visited  by  Dr.  Buckley,  with  all  the  decided  characteristics  of 
Asiatic  Cholera.  This  woman  had  landed  8  days  previously  at 
Quebec;  the  vessel  in  which  she  arrived,  her  husband  declared, 
had  not  been  visited  by  any  sicknes?,  nor  had  she  seen  anv  sick 
persons  at  Montreal,  where  the  disease  had  appeared  on  the  10th. 

in  the  house  in  which  this  woman  died,  three  other  cases  sub- 
sequently took  place,  one  of  which  provea  fatal. 

^n'^'^nrT-^^''  °^^^^^^  ^^  ^^'  ^"^""^  amounted  to  between  50  and 
00.  Ut  this  number  13  were  emigrants;  the  deaths  were  13,  of 
which  4  were  emigrants;  since  our  departure  there  have  been 
several  deaths  more. 

A  canal  is  under  construction  at  Chambly,  a  village  11  miles 
below  St.  Johns  on  the  same  river.  A  body  of  emigrants  is  en- 
ff.f  Vu-\'  T'^?  amounting,  including  women  and  children,  to 
600.  While  the  disease  extensively  prevailed  amongst  the  French 
fbu"  died^'  the  Irish  labourers  almost  entirely :escaped,  and  only 

The  information  collected  by  Dr.  Harlan  at  Caughnawaga  is 
interesting  on  this  point.     This  village,  an  ancient  sittlement  of 

on  ♦;.•"!!.  °K^^  'r"?^  l^"^^'  ^  ^'"'^  °^  ^^^  Iroquois,  is  situated 
on  the  right  bank  of  the  St.  Lawrence,  1 1  miles  west  of  Montreal. 
It  13  located  on  an  elevated  plane  of  secondary  limestone,  covered 
with  gravel  and  clay,  and  contains  1000  Christian  Indians,  under 
the  fatherly  and  spiritual  direction  of  Mr.  Mann,  a  Catholic 
priest,  highly  respected  for  his  devotion,  love  of  truth,  and  emi- 
nent  Christian  virtues.  During  the  fatal  pestilence  which  laid 
waste  this  remnant  of  the  aborigines,  he  exercised  towards  these 

"ualtXttTg"  dl!*'''  '"'""'  '"■^""^°'  ""-■  -"  'P'"- 
•  Communication  made  by  Dr.  Buckley,  of  St.  Johns. 


i 


sins, 


"  ^^BWBWpfe*'*'**!'*!^'^?*'^ 


The  houses  of  the  ^^^^:^^,-t:::S::r:^  ^^^ 

inss.  The  men  are  occupied  2^111^^  enraged  in  making  moca- 
addicted  to  intemperance;  the  «^«"^;^  ^^  ^^^^,  ;  ^.^rs.  A  free  inter- 
sins,  and  do  not  abuse  the  use  of  s^Mntu^^^^^^^^^      ^.^.^   this  village. 

course  exists  with  ^o"  ^^^^  j^;  throu^  the  La  Chine  canal, 
their  route  to  Upper  Canada  otiub 

on  the  opposite  bank  of  the  ';'^;'^-      .^^  „„  ^he  ISthof  June.     This 
The  first  case  of  the  d.se..eapp^^^  ^^  was  intern- 

patient  was  not  known  to  Y;^^'7rits  with  one  of  the  tnbe  just 
derate,  and  had  drank  l'-^«J,y.f£'  individual  at  the  time  had  a 
returned  from  Quebec  J^  f  ;^f^J"t,y  to  the  first  case  with  the 
diarrhcEa,  and  was  attacked  sub^^q'^^  ^died  in  five  hours.  The 
disease  in  a  very  ^^^Y''''\Za'ovSL  of  cases,  and  the  greatest 
„,ales  constituted  the  l^^SfP^^P'^iem,  owing  probably  to  their 
number  of  deaths  occurred  among  them, 
intemperance.  , ,  jgS  cases  had  taken  place, 

From  the  18th  to  the  29th  of  June    i  ^^^^^^^  ^^^^^^ 

and  59  had  fallen  victims  tothj^tos; broke  J,    ^^^  ^^^^^  ^^ 
was  on  the  second  day  after  the  d.seas«^^^^  ^^^  137 

14  died.     The  whole  "^^er  of  c^^e^   1^^^^^  Gazette.     Amongst 
and  the  deaths  70,  as  «*^^^'^;'\?,ee  pregn.nt  women;  prema  ure 

emigrants,  but  attacked  on  the  same  day,  ^^^  exception  of 

the  native  French  Canadians;  2nd    that  ^^^ject  to  the  ^ 

Quebec,  the  newly  ^^'^^^CanSs  and  permanent  residents  of 
ease  than  the  native  t  rench  Canadians  a      H         .^^  ^^  ,nd 

Ptre";oincidence  between  these  facts  and  those  observed  in  Eu- 
rope cannot  fail  to  strike  ^he  attent^onj^  ^^  ^^^  ^^^  ^^^  ,^^. 
The  malignant  epidemic  Cholera,  app  ^^  ^^^^^^  com- 
jects  in  England  and.  Scotland   wherejhe  nom^^^     ^^  ^^^^^ 

^i^^^SlSr^^^XSHf  the  country,  with  an 

iron  hand.  '  ,   ^i^ 

71/f    /     d    that  favoured  trie 
111.    Local   Circumstances  at  f^^ll^^^^^^  us  mortality, 
spreading  of  the  disease,  and  aggravar 

,..  jHe  Cholera  first  made  its 
The  extraordinary  manner  m  which  tn  the  cities  of 

irruption  upon  this  continent;  its  M  dd  "       ^^^  P^.^^^ 
Quebec  and  Montreal,  as  though  pe^'^^^f^  ^^^^^^-^y  that  ac 
them  from  nn  impending  cloud,  with  the 


;( 


I     >i 


10 

^h?J'^u^\  i?  °"''*'  ''"'''  'P''^''^  »  sentiment  of  alarm  and  dread 

thT/estroVc  ^r     f 'd^isTr^i;^^^^      ''^  ^^^'^^"^r"  '^''^'"S  ^«  --' 
i,..^  -^     '  disarm  it  ot  its  malic;ii  character     ns  i\r  -,« 

human  means  can  ni'"!!      Tf  ;=  „.,   •       •  ^       ■"<!.. m-i,   as  lar  ah 

uuciion  01  tni3  unusual  malignancy  ' 

To  prevent  this  in.n     ^    ^^'  ^^•^^l"'^"tly  overflowing  its  banks. 
extreS  of  OuoZ"?'^^^  '  '"""'^'  "^^  ^"^  «^  the  northern 

LawrenS      n  t h i  '"^'    ■'"'""§  »'^°   '''^^'i"'^  ^'ith   the   St 

Therns:;iuencehasTe7to  "7'"^^  '"  "-P"'^'""^  ^-^- 
much,  that  it  flows  in  r     *°  '"^'"'^'^  ''^«  ^^«tcr  i.i  the  ravine  so 

ground  rises  to  4o'Vo;d  caCr  ''T'  *°  '^''^  ^^^^''  ^'^^^  ^'^^ 
rence  suburb  to  tK.s?  f,''' '"^  ''^•'""'  '"  ^^e  St.  Law- 
winter,  the  garbaVe  a^TLr  '  r''  '""'  '^'^^'^^'°"'  ^"'•'"S  the 
ravine  descrfbed  in  r  ow^"'"  u'""'''' ^''"^  thrown  into  the 
carry  it  ofl"     &'"•  e  of  ^f  ""  'rV  '^''  '^'^'"'"S  ^^^^'^^^^s  will 

Along  the  banks  of  this  ravine,  and  V^::!^',.  and  Ian.  that 


11 

1  ,v;th  the  ereatest  intensity.  Of  onehun- 
cross  it,  the  disease  raged  ^^'^^  f  ^^^'i  d,,  Robinson,  occurred 
dred  ca'ses,  ninety,  U  V!^t^Z^los  to  linger  in  Montreal, 
!:;;^-.:r:».eit;irr.nhet..eaiate  vicinity 

-?:-additiontothiscircnn^e,^--t^^ 
progress  of  the  disease,  j^^^^^^v^  police,  the  town  was  filled 
low,  and  from  the  ^^=^",f,"„,,s   the  removal  of  which  was  not  ef- 
with  nuisances  of7^''^",j;^"fi;ad  commenced  its  ravages.  . 

fected  until  alter  the  epidemic  h^^    «  ^f  ^  ^■,;,  from  the  epi- 

2.  Apprehensions  l^^^j^f "  f^"'^',  preparations  by  the  forma- 
demic,  and  the  S^vern^"  ^f  J^^gu  .^1^  ^hen  the  disease  made 
ticn  of  Boards  of  .^^'^  ^^^  .^^ jj^^u,  had  not  commenced  its  opera- 
its  invasion,  the  ^««  ,'^^.'^^,/\';',d  been  adopted,  no  measures  for 
tions,  no  «^'^'t=^;->7^S.^t  "he  elv'^^  "^  nuisances,  the  accommo- 
the  cleansing  oi  the  «f '^'^^X^'^ethods  of  mitigating  the  ma- 
dation  of  the  emigrants,    nd  other  m  ^  ^^^         ^ 

lignity  of  the  ^P''^'^;^'^' j^^^  tn'ged  in  its  own  organization   and 
of  the  disease,  tlie  Board  ^»«  ^"S^^  ^^^,  .,,,  confusion 

everything  with  r'^S^'^  ^°^"^'"ble  preUice,  or  other  motive, 
'and  Lglect  From  ^o-e  unac  ountable^P.^J  ^  ^^.  ,^. ^^^  . ^ 

the  seminary,  a  large,  f"^y' ^'r^^'^"  j,,    .^^s,  as  we  were  infornried, 
Ihich  had  been  oflered  \«  .^^^fP^^.^whi  h  had  not  even  ^ 
refused,  and  the  *^["\f^".t!tL  weather,  without  the  leastarrange- 
which  were  "^^rcshe  ters    om  the  wea       >  ^^^^^^^^^^  ^^^^  taken  pos- 

ment  for  comfort,  ^^^^ ^'"'ZlZ^^.u.  These  were  at  first  without 
session  of  and  converted    ntohosp   a  ^ 

beds  or  bedding;  the  f;f^;^^^^^^"^   Fwen  to  the  period  of  our  arrival 

without  blankets  or  f  J^^^^^  .^'^.ttll*.  beds,  and  the  extent  ot  thei 
more  than  halt  the  patient  weiew.u  j^^^^^^^j.^ees  a  proper 

covering  a  single  blanket,  ^^"f.'  '"  •,3ie;  it  was  a  useless  at- 
rystem'of  -^^-^l^-C^tTtUy  Sd  in  reality  be  regarded  as 
tempt,  and  instead  of  ho^P'^^^^;'  Pf  j^^^^  ^^d  houseless  might  die 

sued.  , ,  ,  nnlooked  for  invasion  of  the  disease, 

3.  From  the  «^^^'^'^^^"^^„^'^  °  ,PP  oach.  the  rapidity  of  its  pro- 
without  previous  ^^=^^"^"S  "^  V,  J^mmunication  by  the  Board  of 
gress  and  extension,  the  «PP=»  "^f^^^'^a  bulletin  issued,  that  1204 
health  on  the  15th  of  Jj'ne  ^^^';^\\\°'  „  ,^  ^hort  a  space  of.  time, 
cases  and  175  deaths  had  taken  pb^^^^^^  ^^^^^^  the 

the  ill  success  of  '"•^^I'-^f  ^^;;^^\'f  "h^se  circumstances  combined  ope- 
resources  of  science  '^"'^^  ^'^ ^^^/..f.^favourable  manner      A  uni- 
rated  on  the  public  ^^"^^ '"J,  ".fa  prehension,  fear  and  dismay, 
versal  panic  ensued;  ^'^/^^'T^d     already  labouring  under  the 
acting  on  the  systems  °^^^""f 'Served  to  influence  a  cotnmu- 
universal  predisposition  ^^^'f '^^^^^        developed  the  disease 
l^t^^^:^S:  KS  in  wS  without  theseexciting  causes, 
it  would  have  remained  latent. 


)   I 


12 

the  present.  The  commotion  indKh  '"/reat  force  as  in 

cisely  in  the  same  line  of  rpesZ  ,vir  T'^'T'^  '""°''  ''''  P^^' 
disease  in  its  most  dangerouf  s  'e  ,^^'' iVf  ^'"''"^>^  "^  '^' 
form,  or  there  is  merely  a  strnrw?       .  "  ''  "^"""'^  '"  't^  mild 

sentiment  of  fear  Td  atnfsuZnlTX"'""  V,  ""  "^^^^^  ^^o 
attack  in  its  worst  form  hit  o  .1.^  '  '"^^'^-^'^'y  brings  on  the 
all  important,  thereJore',  o^el?  Xi dClTT'  'f'^'^'  ''  '^ 
so  as  to  •  .ok  on  the  disease  vvlth  L      '  ^'s^'pl^ne  the  mind 

t  is  a  high  and  important  clntv  in  nrnfl^^'°'''?''°"  ?"^  ^««olution,  and 
lie  authorities,  to  avoid  a  ''--•''''"  gentlemen  and  the  pub- 
alarm,  but  to  makrnre,  is  f  r '""V^'"'"''"'^''^  "«  «''g"s  of 
every  mark  oTcooheTlT^^^ 

perfect  confidence  in  JheVJlt  nt  'r °"'  '""^   assurances   of 

are  obse.     d  with  exactnf^^t'nrr^grdly  a"  iSli''^"'  ^"^"  ^'^^^ 
ed  t:^r  u! -£- - -^^^  a  most  decid- 

^^ur-XSy^-^^^^^^ 

of  disease.  In  Canad  party  t?'fehr'"^  "  «"'  exciting^ttacks 
great  lengths,  the  passions  had  be.n  P'"""^^^^  this  spring  to 
treds,  and  personal  animosites  vver"  [^T ' r'T'^''^^'  ^'"^  f^^" 
These  feelings  had  not  sub  S Tv, '„  V^'^  '^e.ght  of  bitterness, 
c'.ty.  Not  only  did  the  excitempn  J^l^P"^^'"'^  burst  upon  the 
vidually  unfavourable,  buTthevexi  '^''"  ^'T^^'  P^°-«  ^"di! 
by  paralyzing  p.  ,lic  ^e  su  es^r  sani^r  '."•  ""'^'PP^  ^"«"-"ee, 
nefic.al  suggestions  and  liberal  altl  ^  °Y'^''  '^^e  most  be- 
!vere  rega'rded  with  a  ealous  eve  'r'"^-^''°'"  '^'  °"^  P^'-^y, 
intention,    and    were   re  e^d    bv  'tbP  °7,^'"''""S  '"   a   siniste 

n-muyforthepublic  welae    there  r  ?/^' r   -^"^'^^^   «^  ""a- 
and  distrust.  '  '''^'''  '^^'S"^^  division,  distraction 

Jextz';::Scn^^  -ited  to 

of  that  under^which  they  so  sT-r.7"  ^TT^  '^'  ^^aracte  s 
largely  of  ardent  spirit  ,pL  but  nS.rT'''^'  '^''^^  ^°"«"'"« 
comfort,  make  use  ofafo^od  crude  in  n"°"  l^,  cleanliness  and 
mostly  of  a  single  story,  with  onfined  r"'''  '"^  ^T  '"  ''^^"'"g^ 
sleep  on  the  ground  Jloor  This  tt  r"'''  '"^  consequently 
known,  in  all  epidemics,  is  one  of  thi  m  ?'="'"«f^"c^.  it  is  weH 
vitmg  attacks  of  disease.  '"'''^  ""'■^«'"  means  of  in- 

r'^^oUutZl^^^^^^^^^  the  bad 

lime-stone,  mixed  with  cavwh^rh  J- '°'i ''' '«^t  secondary 
Springs  are  deficient,  whi  e  Se  well  wlf  ''°'?.'^  '"  '^^  "'ater^ 
bad  tasted.  The  wate'r  of  he  rfveTs  L  ehfeV'  '''^""^  '^''^  «"d  is 
habitants  of  the  country  whinh^fU  ^^  consumed  by  the  in- 
on  their  banks.  aCI'  Monta,  thVotH  °'  ^'^'^  -"g-gating 
rence,  forming  at  the   iunrt.nn  n/  lu  '"'"^  ^"ters  the  St,  Law- 

Montreal.     The  r  verfrh       u      -^^"'^  ''^^^t  floods  the  island  of 

Jtream     The  St!  W'e    e^^  tht trt  "^if  'T  '"  ^  ^'-^ed' 
from  the  n-reit  hi--  P^'^c  pellucid  wat°-°   ;--- 

=re,(  lak„,  ^,,3,,  „„  ,^^  ^__^_^_^j,^  shore,  whiie'thr.u;? 


4 


■:6 


.1 


Ua  Ottawa,  connned  to  ^^ ^^^^^^^^I^J^sI^ 
of  Montreal.  This  water,  «hargerf  with  jmpu^  ^idWitudes  of  tem- 
the  inhabitants.    Combmed  w.  h   he  f  e^^^^^^^^^  ^^^  coolness  of 

perature,  the  oppressive  '^^^\°'  '' .^JyJ^  cause  of  the  frequent 
[he  morninss  and  «vening«,    is  probably  ^^^^^^^  ^^^^^^^^ 

affections  of  the  stomach  ^^""^  .*  "^/^^f^^a  tended  to  the  aggra- 
which  are  endemic  diseases  of  this  city,  am 

ration  of  the  prevailing  epidemic^  added  the  large  body  of 

To  the  foregoing  local  causes  ^"8^  be  a"  ^^  ^3 

emigrants,  who,  from  being  '^J\l'.^l'['^l^^^^^^^  destitute,'  and 
appropriated  to  ^'---f^^^^'ljalhav 'escaped  under  these 
forlorn  condition.  That  so  "^^yj,  ^han  that  they  should 
circumstances,  is  ^^^^er  matter  of  surj  use,  i  ^  ^„  i,,  doubt- 

have  afforded  so  many  ^'cfms  to  the  disease^  i       ^^  ^^^^^ 

ed,  that  had  proper  ^'^^^•^'"'^I'f^^^X  localities  where  the  dis- 

had  they  and  the  lower  PoP^l^^'^^'^/^V^atful  highland  in  the 
ease  was  most  rife,  been  encamped  0    the  be^^^^  ^^  ^S^     ^^^.,^„^^ 

=^r=-ra^:^^rt!;ut^i.u^^ 

and  its  virulence  earlier  abated. 

/.  T       ru.    TJnhit^  of  Life,  and  Disciplinary 
IV.  Influence  of  Locakty^HaM^^^^^^   LJ 

U  treating  of  the  local  causes  -^^^^  ^^^^tr^lc^  J^s  r: 
disadvantageously  the  character  ofhed,^^^^^^^^^^^^^  ^^^ 

stated,  that  two-thirds  of  he  cases  we  ^^^  ^.^^^j 

or  in  the  streets  immediate  y  »dj?^«"\;;     j„  Quebec  commencrd 
which  almost  bisecis  the  c  ty.     ^ he  ^'^^^  ;  \,  ^^  ^ul-de-sac,  a  low, 

and  was  chiefly  P^ ' '"'  ^  f  thrcUv    c  owded  with  emigrants  of 
confined,  iU-ventilated  P^.^ .^^  ^e  f  y-  cro^^  ^^  ^^^^     ,,, 

t:^^''^^:^:^:^^^  that  f^umlshed  a  constant 
-^S:iS:  Helens,  opposite  ^.e^^ower  su^^^ 
treal,  displays  the  influence  ^^^^fl^^^Vin    he  Quebec  suburb, 
troops  were  stationed  '"  ^arrac^s  ^^^^^^^^^^^  ^r  it  broke  out 

The  disease  appeared  ^"^^"^^^^^"J^Xr  transferred  to  the  island, 
in  Montreal;  /hey  vvere  a  few jkys  al^x  ^^^^  ^^^^  ^^^^^^ 

and  in  three  days  from  their  removal  ,  ^^^^  ^  ^ 

The  number  of  cases  in  the  g'^;"^ J^'"   children.   The  same  cir- 

2  childrcn_of  which  3    f '^^^'^J^^^^Vrnent  stationed  at  the  La 
cumstance  ^vas  observed   nanoth^^^^^^^^  ^^^  ^  „,„,ber  died. 

Prairie  barracks.     1  he  troops  i^eca  ^.^^_^^^  immediately 

They  were  removed  to  .ae  island,  anu 

ceased.  „  i:^t.Qtnnp  rock,  overlaid  with  a  dry, 

•.L..  -,f  U"  otmnanhere. 

pui"i!.y  01  ii'?  "i-i-ii — J--- 


14 

Although  the  troops  were  encamped  on  the  island    n  mnnl  of 
St  the  r""  "r  ••'^^^"-'  ^'-!y'  ^0  '-  «tatio.?e;i'  at  f    Irer 
ed  wi         !  r^'"  ^'"';'?«  '^''  '^'y  '»'"'  «>!«'>'.  yet  non.,-  were  attack- 

Tf  L  "■     exercised  by  ibe  medical  oilicers  over  the  health 

whi  Vr^'  "^'  "»Po««i'^ility  of  irregularities.  The  so  Ir 
vh.lc  on  duty,  cannot  indulge  in  any  excess,  and  on  the  islan  h 
was  not  u.  h,s  power  to  gratify  his  ^ricious  p;opensities. 
cibe  mannor  T''  "  ''  '"/P^f  i''!-  "ot  to  be  struck  in  the  mostfor- 
trouled  rr.'  :r\  f^'^r^''^^^  y  th-^  terrible  affection  is  to  be  con-, 
trouled  and  baffled  by  attention  to  the  salubrity  of  a  residence  and 
strict  disciplinary  regulation.  ^  itsiuence  ana 

Tr2  R^'vlr.''  "■t""'^7  ''  ^-^^"^Pl'^'^'l  '"  other  instances.  At 
a  sTdv  snil  '  r'""^'  ^''^'"'^"  ^^^'^'^'^  ""^'  Montreal,  which  is 
a  sandy  .oil  and  elevated  position,  and  at  which  the  emigran  s 
land  ,„  g      t  „„^^,,^,.^^  ^,,^  ^,.^^^^^  ^^^^  ^^^^  1,V  t-iT  fs  Jo 

^ich  is  out  of  the  rc^;;^^nhe  c;^:g!t:i::;K^^,;^,:ttl2 

but  which  lies  low,  in  a  damp,  wet  soil,  the  disease  LsnrevS 
wuh  great  vioence  among  the  Canadian  residents  and  XJs    ' 
Sorel    vvhich  is  also  situated  on  a  dry  sandy  soil,  at    he  rn^uth 
of  the  Richelieu,  has  escaped  the  disease,  while  it  has  ralZ^ 
grca   violence  at  Chambly,  a  few  miles  above,  on    he  si  h- 
and  l.as..ppeared  at  Isle  au  Pas  in  the  river  immVdi^tdr^pJS 

nifol'V-f^'lf-  ""''.'"S^'  '^''-^  ^''^^P^^  =»  Visitation,  or  the  disease  mi 
e  s  ea's  I V  m  ilaVo'r  '''t'^^^-^^  of  disordered'stomach  and    oTv-" 
-aiirnan'  typ"''''  ""'  ^"'"^  rise  to  but  few  cases  of  its  more 

In  these  instances  particular  circumstances  mitigate  the  enerirv 

tlZrfT'r ''''''  °'  '''''^  ''  '"^^I'^y  the  character  and  rei/n^ 
ing  type  of  the  disease.     These  circumstances  properly  seized^or 
and  duly  appreciated,  are  of  the  highest  consequence    for    thoud 
may  not  be  within  the  limited  power  of  ou?  very  finite  eanad 
e    to  ascertain  the  natural  causes  in  the  action  of  whi  1    n^^^^^^^^ 

rlv  tZr  "'^""''''  T  '"  '^'  P°"^^  «^'  '^^"^'''"  g  ney  0  le". 
t  oTnn  1  n'T'''  ^'^'  ^/  ^^'•^•'•"'"ing  the  laws  of  their  prod uC 
ener'r  rP  ^Z  ""'"'''"^  phenome'^na,  we  may  controul  Te  r 
^^^!:Z:^^^''''  °^  '''''  prevalence/and  abate  It^y 

flup^l^'^f  "-^^'-f'  ^''''^''  "'^"'''''  '°  "^"'^'^  of  notoriety  from  their  in- 
fluence .s  predisposing  and  exciting  causes  of  diseLs  TreS  v 

Still  if         1 ,         ,  "''^  ^^  supererogation  to  enlarge  on  thissubiect 


15 


'iz^:!:"-^:^^--^^^ 


that  arc  not  to  be  attri- 
cc  or  impru- 

S"  oVtho' part  ol-  the  P;\f'^>"\-  ^.j-nininE  an  unrivalled  su- 
''"j,ulor  thisla-n  the  ha  .t  o  .Jc,  --^^  J,,,,  ,,  the  use  of 
...cmacy  in  its  V^^^"^'^^'^ ^^^l;^ ^ho  .^  perfectly  tenr,pcrate 
'ardent  spirits.    It  is  true  t»^-^   P^f  J  ,,^  a^^rase,  and  even  become 

in  this  particular  are  the  subject,  o      he  <i  ,    ^^,,,^,y^^  to  the 

s  vicl.-.;  but  these  a.^  ra  e  -^^^^^  ,^  ^^,,^,,    in  Mon- 

numbers  of  the  uUemper  te  -J.o^^^  u^  ^^  ,^^, .,,,.,   .„temper- 

treal  we  were  ;'^'-;-  ,.'  .^".^.t  m.>st  sutfer  from  tbY^X' ha 
nnoe  rccovcrcii.     I  nt,  oi^ji'^  .liscise,  are  placed,  by  tin.  na 

"ortho  morbihc  cause  ^-^-f-^^  .fof  U-  clis'-c.  They  have 
bits  of  intemperance     n    lev  e  y  ^.^-^.a  ,,y  «  sound  con- 

already  passed  tl>e  first  ^>^P^'  l^'J^^y^i^,,  i,„s  already  been  bca  en 
stitution  to  the  prosress  «  '^^^^  ;>;^J^^;  ;,,  onward  course-.t  ,s  a 
aown-nc  obstac  e  .s  \^^^^^^  ^  sunk  into  the  prostrated 

witnessed.  .  ^     .^^ethcr  of  a  moral  or  physical 

intemperance   in  other  rcspcci  ,  constant  intem- 

na  ure,  though  less  destruc  ive   banj^he  u  ^^^^^^^^^^^^  ^^^ 

porance  in  ardent   iquors  ^^^  «   ^^  ,,,,  equilibrium  in  the  force 
possess  the  general  cilect  ot  d  sturD    y  ^^onomy,  and  in  this 

li  the  various  organs  ^"'^If  Jf^^^^'^inrrnorbific  impressions,  and 
manner  destroy  its  P"^-'"l^^Vth?St  influence  exerted  by  the 

:?;:;:^^;or^-h:ro:^nawhich  would  othe^ 

^Tlla:^;  a  ve.y  f^rt^^^J^:l^^^lrZs 
demie  has  spread  its  ^^^^f  ;'';f,  7:f  Jawing  hand  those  happier 

of  society,  touching  ^  ^\*^,Xcumstances.^   This  general  obser- 
individuals  l.lessed  vvitl  easy  era  ^^^^^^  ^^^^^^^  ^^ 

vation,  though  '^l^^l.^,^^  .  f^.'P  "as  veiified  at  Quebec  and  Mon- 
marked  peculiar,  les  '"^*j^^;^f>ji;uiuals  attacked,  and  especially 
ireal.  The  greater  ""'^be;°J/,"4'"i„^  class  of  the  emigrants, 
of  those  who  Per'«  ^'^'^^ ^'''"^  °iVn     The  most  numerous  exceptions 

and  resident  or  "»^7'^,  .'^J^X  *  "^^^  "^^''"'^  P*^^^'*^^'^  ''''  ^'^  r 
to  the  rule  occurred  '^'l'\^^'^''' ^^Uonire.\,  from  the  existence  of 
tion  of  both  cities  for  a  '''^^-  Jl^\\-  ^he  disease,  more  of  the 
«o  many  ''.-"'U'.'^'^''!\^^"'!!:S  tb  n^n  Quebec.  In  this  latter 
better  orders  o  «-^:',^^y  1?^^  ,t^'^  b  "ge  eoffee-house,  and  who  are 
city,  of  3(i2  subscribers  to  the  excn.    g        ,i,cumstances,  only  one 

-■qiL,.ea,c.prev.e„ceof^U.ca;^»»e.;nt_^^^^^ 

population,  """". «;""■"=  !,'!°"\„u,Krs,  which,  unitcl  to  aliment 
&aUalhals.oss".«o'^P«'""«^/''™.';,„V,ia,cd,  crowded,  and  un- 
of  inferior  qualily,  small,  ™'='  "  .  „  „(  „„  ,he  circumstances  in- 

t^l^^^^Z  •:,;»::':' r:a5,ravati„g  its  Caracter,     - 


In 


I 


16 

a.  n,o„  f„,„,„,|^  i„",h':'i,  •    L     "Thai'-'tr"""' 

suiJer  111  irreater  mimhfTM-  )...»  ;...  <  us.xls,  mat   the  poor 

«ence  an.hnat.en  n  to  det  i  s'7n"'"'^^'  ''"'"■"''^'"->  "'g'i- 
ricl.  or  the  poor,  the  high  r  th  W  lo  a,:  llv  ""'  ."""^-^  ''" 
and  excitative  of  the  attacks  of  the  .he  se  Anl  '^'■^'^'«!r'"S  "* 
subjecting  the  poorer  classes  in  Ir..;  ^\""t'i«''  prolific  cause 

their  subsistence.  Tl  e  e^xt  jf^Vo  f  "''''"'>^  °''  ''''^°"''  f"'" 
Jabour  in  the  midcl.v  sun  i,  m  ''V'?*^""  ^'^P^^'^'ly  indurcd  by 
tbe   malady.     ,n   iU  r'        vT"*^     "^'r'"''''  ^°'^'"""  ««"^^e«  o^f 

to  the  open  a  r  suffered  ffreatlv       \r„     f  n  "^  occupations 

ontheir^houlders/'     ^E^^cts    nL'/t^^     "'"^  ^'^^''-  '^^^^ 
the   prevalence  of  the  eni Temif  infl  '  "]•'  P''°P'-i«ty    during 

during  the  hours  of  greatcSe,t  "'  "^  «"«Pending  labou? 

ii-o^;i-&r:-c;^e^^^ 

were  stationed  in  fine  fofty  barrackfTn  th"  °^"^'''°-  ^  '^^  troops 
possessed  the  advant.ses  of  .^^1  K  ^^^"PP^''  town,  and  so  fir 
ments  were  daily  poS  in  dV^r/'""'-''^"''^^  ^"t  ^^tach- 
and  lower  town  a^Pgurd.^^^^^^  '^°^'^  <^f  the   upper 

citizens  to  the  co.^^^tus  ^If  ThVrea7"N?'"ir''r'^^ 
ever,  was  permitted,  when  not  on  euar  to  i..  /u  "^u""'  '^°^^- 
unless  accompanied  bv  •,  nnn  „«  ^  '  !°  ^^^^^  ^'^^  barracks, 
hi.  conduct.  'Every  ^pe^Uon^wrrr'  f '=''''  '"^^Ponsible  fo; 
perfect  deanliness,  Lropreve„t.vo''  ''  P'-^«'^''ve  the  most 
prudences  of  which  so  d  erraT,.  ''','  "^'^^P^'^'^  to  the  im- 

i"g,  the  garrison,  In    ;;;«„    ^Xh^  Every  morn- 

underwent  an  insnection  VnTnv  '^^'?''d';e"'  ^ere  mustered  and 

so  as  to  detect  thcf^r  t  "  "  "5?'"  ,'°"  ^^^'^  '"^^'^^'  °ffi<^«", 
occurred  in  the  bar  ckS  Mnn7  ''J'  ^°.'  ^  ^^^^  o^  Cholera 
after  the  commencemen  o  t  e?p ^ Sc  'T''  '"^'^^V'^'y^ 
feeble  constitution,  who  lodged  mtZ  A'  1 1  PP*"!"  ""'^  "''"^'  ^^ 
and  is  the  only  ea^  knollo^hlve't!:;  t '  ""  '""   ^"^^'^"'> 

Combining  together  in  a  general    V,  i-  ^t    r 
t^ons,  weobtain1hefollowinTs:lt;'ofttI^^°'"^  °'^^^^^- 

ani  MoIl^LTtd'i'n  :K'dt:^r  ^'r^^^r"^'^^^  Q-bec 
tions  the  who  e  line  of    h^StT         '^''^'r  '^^^'^  ^""^  ^^^^  ^^cep- 

PrescottandOgdensb  rghonth^^^^^^^^^^  '?^'°"  ^^^bec  fo 

on  Lake  Ontario.  ^  ^  nver-and  York  and  Kingston 

ir^fprViolftotl  br?atTo"l'fl"r^'  at  Quebec  and  Mon- 
in  health.  "leaking  out  of  the  disease,  but  who  continued 

3d.    That  the  circumstances  in  which  thesp  -    •        . 

wiiicn  mese  uuugrants  were 


;«- 


the  passage.  .        r .,     vovnjtos  was  from  fifty  to 

51...  ™  the  average  dura  .on  of    K^^^^^  ^^  ^^c 

eighty  days;  while  the  P'^^^'^"   '"'   f aevelonment  of  the  symp- 
tiL  Lm^xposure  to  its  cause  and   h^^^^^  f,„^  H, 

toms,  so  far  as  ascertained  ^Y  tJ^«J''«l°;y  ^^  „^^     ,„  fourteen  days, 
commencement  to  the  f«f"^Xvesel  on  hoard  of  which  cases 
fith.  Tiiat  the  Carr.cks,the  m.ly  ve  ««   ?"  ^^^^^  „,^ 

of  Cholera  had  taken  place  hefoe  hr  a  ma       JJ^^^  .^^  ^^,3ges 
the  8th  of  June,  the  day  ^vl>en   he  d  sea  e  cov  ^^  ^^^^^^  ^^^ 

in  that  city,  actually  '" /l-^a^^^^^  ^^^  I^ase,  in  the  shed  on 

from  each  other,  and  who  had  "«  P[^";°^j,„^8  did  not  hegin  to 
8th.  That  in  Mon.'-cal,  the  Ei.gh  h  lesu  _^^^  ^^^^  ^^^ 

suffer  from  the  disease,  until  the  17th  oi 

mortality.  nvUtinir  in  Quehec  and  more  parti- 

11.  Thot  numerous  causes  existinf^  in  ^*  extension  and 

cularly  Montreal,  concurred  t°«^,f^^°"',„d  impressed  on  it  the 

propagation  of  the  disease  in  those  c  tics,  ^"^^^'"^^^ifegted. 

?  rulent  aspect  and  malignant  charact.    it   here  njan         ^^  ^^^^_ 

12.  That  those  circumstances  ^o  n^^  ex.st  m  th        y  ^^^^ 
Uelphia,  and  with  some  degree  of  '^o^M.nc-^  we    Us%revalence 

a  mild  visitation,  and  ^'^'"Pf '-^'Hf  anoerthat  it  ,viU  be  confined 
in  the  epidemic  form;  or  ^^ould   t  appe^^i ,  th=»t  ^^^^^^^  ^^^^. 

10  the  close  lanes,  alleys,  and  "J^' °  ;^;;;';',  ;i  Jbe  procured, 
ments,  where  ventilation  ^""^^l^  J^  ^  '  "^j Ss  calculated   for  the 
13    That  a  system  of  municipal  r..guiauu  sa„itary  police 

p.:fervLlon  ofL  ^'^'^l^l^'^ :S^;''l::f,    Z  4Ze  of 

«""Sfrl°hf  reo;ie      -Sfof  tl.e  epWcmic,  in  U,e  form 

:;l'"£:eTti'lngn-'a»J"-S-fto  .  -trict  personal 
14.  That   inJiviJuals,  by,»»»Si;.,  and  moderation  .nail 


.  -^^^jA.  -i-'JfW*'*'''^'^'*; .  -^j^-  4 


18 

'  dence,  may  preserve  themselves  amidst  the  pestilence,  perfectly 
exempted  from  a  malignant  attack,  which  is  alone  to  be  appre- 
hended. The  disease  is  thus  placed  in  a  great  measure  under  in- 
dividual controul. 

15.  That  instruction  in  this  important,  and  we  believe  universal 
fact,  should  be  carried  home  to  every  individual  of  the  community. 
This  may  be  accomplished  by  a  few  simple  rules  and  precepts, 
concisely  and  clearly  expressed,  published  and  largely  distributed, 
placarded  on  the  corners  of  the  streets,  alleys,  and  lanes;  affixed 
to  places  of  public  resort;  placed  in  a  conspicuous  position  in  all 
the  taverns  and  boarding  houses  of  the  city;  taught  in  the  public 
and  private  schools  as  a  portion  of  the  exercises;  and  above  all, 
enlarged  upon  and  enforced  by  the  moral  instructors  and  spiritual 
guides  of  the  people,  with  all  the  eloquence  and  talent  that  adorn, 
and  the  holy  reverence  that  surround  the  sacred  desk. 

Part  2d.  Medical  Account  of  the  Disease. 

GENERAL    REMARKS. 

I.  So  much  has  been  written  and  published  within  the  last  two 
years  on  malignant  Cholera,  under  various  designations,  that  it 
might  be  thought  prudent  and  excusable,  should  we  omit  entirely 
to  enter  on  any  medical  notice  of  the  disease.  The  press  has  lite- 
rally groaned  beneath  the  weight  of  publication.  Notwithstanding 
hese  numerous  efforts,  and  this  amount  of  labour,  it  must  be  con- 
fessed, that  a  corresponding  progress  in  arriving  at  positive  know- 
ledge of  the  character,  nature,  and  method  of  treating  the  disease, 
I  has  not  been  accomplished.  The  evidence  of  this  is  presented 
in  the  discrepancies  of  opinion  and  the  discordancies  of  views 
that  are  earnestly  maintained;  the  conflicting  theories,  the  oppos- 
ing numberless  systems  of  treatment,  all  equally  conjectural,  un- 
certain, vacillating,  vague,  and  unsatisfactory  in  results,  that  are 
daily  promulgated  and  warmly  advocated.  Truth  is  simple,  strik- 
ing, and  convincing.  When  once  discovered,  then  rally  around  it 
unprejudiced  inquirers^  the  candid  in  sentiment,  the  true  lovers  of 
knowledge,  and  a  unanimity  of  opinion  soon  begins  to  prevail;  for 
facts  presented  in  their  just  light  are  seen  alike  and  acknowledged 
by  all.  Diversities  of  opinion  on  the  same  subject  are  generally 
proofs  of  obscurity  and  ignorance,  and  numerous  remedies  for  the 
same  evil  is  conclusive  evidence  of  the  little  utility  of  any.  In  this 
unsettled  state  of  the  question,  we  may  be  permitted,  without  ha- 
zarding the  charge  of  presumption,  to  offer  the  results  of  our  ob- 
servation on  this  formidable  epidemic. 

Before  proceeding  to  speak  of  the  disease,  a  few  general  obser- 
vations on  epidemic  diseases  will  tend  to  illustrate  some  of  its 
characters. 

A.  Epidemic  Influence  or  Constitution. 

The  influence  or  remote  cause  giving  rise  to  epidemic  diseases, 
is  unknown.  A!!  that  has  been  written  on  the  sulijecti^mcre  con- 


^!ar 


19 

jecture,  and  deserving  no  serious  attention.  It  is  probable  certain' 
information  on  this  subject  is  not  attainable,  from  the  imperfection 
of  our  means  of  research,  and  the  finite  power  of  our  senses. 
Though  we  may  not  penetrate  the  nature  of  final  causes,  yet  we 
can  seize  on  the  phenomena  they  develope,  we  can  determine  by 
cautious  observation  the  modes  in  which  these  are  produced;  we 
are  enabled  to  appreciate  their  true  character,  and  to  unfold  the 
laws  by  which  they  are  governed.  This  is  the  only  knowledge 
man  can  boast  of  as  positive:  it  is  that  which  he  can  alone  render 
available  for  useful  purposes  in  his  present  mode  of  existence. 

Epidemic  diseases  are  to  be  studied  on  these  principles.  In  a 
philosophical  view  they  compose  great  problems,  the  solution  of 
which  will  furnish  the  basis  of  sanitary  municipal  regulations  for 
the  community,  and  fortify  the  moral  discipline  of  society.  In  this 
light  they  are  to  be  regarded  as  important  lessons  to  be  studied  as 
yielding  wholesome  instruction,  and  not  in  the  light  of  vengeful 
acts  to  be  deprecated,  as  inflictions  for  olTences  with  which  they 
are  unconnected. 

Some  general  principles  in  relation  to  epidemics  may  be  consi- 
dered as  v;ell  settled. 

1.  They  are  partial,  as  pervading  a  city,  district  of  country,  or 
an  entire  continent;  or  universal,  as  sweeping  over  in  succession 
a  zone  of  the  earth. 

2.  The  grand  line  of  march  of  universal  epidemics,  is  from  the 
eastward  to  the  westward,  though  they  exhibit  jit  the  same  time 
an  irregular  and  sometimes  a  diverging  course. 

3.  They  are  confined  to  zones  comprehending  a  certain  number 
of  degrees  of  latitude.  The  influenza  of  last  winter  did  not  reach  as 
far  north  as  Montreal,  and  it  does  not  prevail  at  the  same  period 
in  both  hemispheres.  The  dengue  which  travelled  as  an  epidemic 
the  circuit  of  the  globe  a  few  years  part,  was  limited  to  the  south- 
ern latitudes  of  the  northern  hemisphere.  As  yet  the  most  south- 
ern point  of  the  present  epidemic  has  been  the  Mauritius. 

4.  The  duration  of  the  epidemic  influence  or  constitution  va- 
ries, being  prolonged  from  a  few  months  to  several  years.  The  in- 
fluenza seldom  continues  longer  than  three  or  four  months  in  any 
one  place;  it  travels  rapidly,  and  generally  completes  the  circuit  of 
the  globe  in  about  twelve  months.  The  eruptive  diseases  when 
epidemic,  as  small-pox,  scarlet  fever,  and  measles,  are  slower  in 
their  movements.  Sma!l-pox  and  measles  generally  prevail  from 
one  to  three  years;  scarlet  fever  from  three  to  five  years,  and  they 
occupy  from  ten  to  twelve  years  in  their  circumterraneous  course. 
The  present  epidemic  has  occupied  fifteen  years  in  its  progress 
from  Bengal  to  the  continent  of  America. 

An  epidemic  constitution  that  gave  rise  to  yellow  fever,  high  bi- 
lious remittent,  and  intermittent  fevers,  commenced  about  1790 
in  the  United  States,  and  continued  to  1805.  During  this  period, 
every  summer  cases  of  yellow  fever  occurred,  and  it  was  at  times 
epidemic.  This  constitution  disappeared  until  1819,  when  it  again 
returned,  acquired  its  acme  in  1825,  and  has  since  declined. 

While  the  epidemic  infiuence  endures,  the  disease  u  generates 


20 


'1 


I 


\ 


continues  to  recur  at  different  intervals,  until  the  epidemic  consti- 
tution is  exhausted.  It  is  not  improbable,  from  all  appearances, 
that  malignant  Cholera  may  for  a  time  present  this  character. 

5.  The  epidemic  influence  is  not  confined  to  the  human  race. 
All  organized  beings  suffer  from  its  operation.  The  epidemics  of 
animals,  or  epizootics,  have  become  an  interesting  subject  of  inqui- 
ry, and  throw  much  light  on  epidemic  diseases  generally.  The 
blights  which  affect  plants  very  extensivel}  ,  are  epidemics  amongst 
vegetables.  The  whole  of  the  forest  vegetation  was  remarkably 
backward  in  Canada  and  exhibited  an  extreme  languor,  while  an 
immense  number  of  the  trees  had  perished.  It  was  generally  sup- 
posed they  had  been  killed  by  the  winter  cold.  Yet  this  seems  ra- 
ther doubtful  of  the  hardy  forest  trees. 

6.  The  epidemic  influence  or  constitution  is  especial  for  each 
particular  epidemic.  No  one  epidemic  can  be  taken  as  a  standard 
by  which  the  others  are  to  be  compared,  examined,  and  judged  of, 
but  each  must  be  investigated  in  reference  to  its  own  phenomena. 
The  epidemic  influence  or  constitution  appears  to  act  on  certain 
organs,  and  affect  certain  functions  of  the  economy,  disordering 
or  disturbing  their  natural  or  physiological  phenomena,  and  alter- 
ing their  natural  mode  of  being,  and  thus  producing  an  especial 
predisposition  io  a  certain  form  or  class  of  diseases,  in  preference 
to  any  other. 

7.  The  epidemic  influence  or  constitution  is  essential  to  the  pre- 
valence of  any  disease  in  the  epidemic  form;  even  of  diseases  no- 
tedly contagious.  Small-pox,  measles,  and  scarlet  fever,  are  con- 
tagious diseases,  and  at  the  same  time  are  epidemic  or  sporadic, 
according  as  the  epidemic  influence  may  be  existing  or  absent. 
Before  the  introduction  of  the  practice  of  innoculation  for  small- 
pox, it  prevailed  epidemically  at  intervals  of  twelve  or  more  years. 
After  innoculation  became  general,  individuals  affected  with  small- 
pox always  existed  in  society,  but  the  disease  did  not  assume 
the  epidemic  character,  except  at  certain  epochs.  There  was 
something  wanted,  which  was  the  epidemic  influence,  imparting 
the  predisposition.  Since  the  abandonment  of  the  practice  of  in- 
noculation and  the  substitution  of  vaccination,  small-pox  now  pre- 
sents its  original  character.  It  disappears  for  a  series  of  years,  or 
manifests  itself  only  in  the  sporadic  shape.  This  circumstance 
from  being  misunderstood,  led  to  a  belief  for  a  time,  that  vaccina- 
tion had  actually  exterminated  small-pox.  But  this  pleasing  de- 
lusion was  dissipated  by  its  recurrence,  accompanied  by  its  modi- 
fied congener  varioloid,  in  the  epidemic  form,  when  its  specified 
period  arrived.  This  has  now  become  the  settled  habit  of  the 
disease.  The  same  observations  are  applicable  to  all  the  eruptive 
contagious  epidemic  febrile  diseases. 

They  are  equally  true  with  respect  to  other  febrile  epidemics. 
During  the  influence  that  imparts  the  predisposition  to  yellow, 
bilious,  and  intermittent  fevers,  putrid  eftluvia,  marsh  exhalations, 
moral  commotions  of  the  intelligence,  indiscretions  in  habits  of 
life,  and  numerous  other  causes,  which,  at  other  periods  would  be 
innocuous  or  causu  a  slight  degree  of  disorder  in  some  fiiiiction  or 
organ,  now  become  exciting  causes,  developing  those  greater  ma- 


J^l 


21 

ladies.  The  same  facts  applied  to  other  epidemic  affections,  and 
particularly  to  the  present  reigning  disease,  which  is  excited  into 
action  by  the  same  causes  that  before  produced  former  epidemic 
diseases. 

8.  Epidemic  influences  or  constitutions  recur  periodically  at 
different  intervals.  Influenza  recurs  at  intervals  of  six  or  seven 
years;  small-pox,  measles,  and  scarlet  fever,  reappear  at  periods 
of  from  twelve  to  fifteen  years.  The  various  forms  of  epidemic 
gastro-enterites,  yellow,  remittent,  bilious  intermittent  fevers, 
and  the  same  diseases  with  typhoid  characters,  have  manifested 
periods  of  from  fifteen  to  seventeen  years.  These  periods  are 
stated  not  as  positively  accurate,  but  as  approximations  to  the  truth. 
More  time  than  is  at  our  disposal,  and  a  reference  to  numerous 
works  would  be  requisite  to  establish  the  exact  intervals  and 
periods  of  each  epidemic.  The  preceding  views  are  the  result  of 
the  recollections  of  general  reading  and  observation,  and  may  be 
liable  to  some  inexactness,  though  the  principle  will  be  found  cor- 
rect. 

II.  The  Prevailing  Epidemic. 

The  present  reigning  epidemic  having  ravaged  Asia,  and  over- 
run the  great  portion  of  the  European  continent  in  its  desolating 
march,  has  reached  our  shores  and  threatens  to  carry  its  devasta- 
tions into  every  portion  of  our  country. 

The  generic  name  of  Cholera  first  given  to  it  in  Bengal,  has  been 
universally  adopted,  though  a  variety  of  special  appellations  has  been 
bestowed  on  it.  The  term  has  most  probably  been  unhappy.  The 
disease  is  certainly  very  distinct  from  common  cholera  morbus, 
though  it  presents  some  features  analogous  to  that  affection.  It 
bears,  however,  analogies  quite  as  strong  to  other  diseases.  The 
name  too  has  led  most  probably  to  treatment  very  generally  based 
upon  the  usual  remedial  proceedings  adapted  to  common  cholera, 
but  the  propriety  of  which  may  be  well  questioned. 

Many  discordant  opinions  have  been  advanced,  each  of  which 
has  been  more  or  less  earnestly  advocated,  respecting  the  proper 
character  and  true  nature  of  this  formidable  and  very  peculiar 
disease.  They  may  be  approached  probably  more  nearly  by  an 
analytical  examination  of  its  distinguishing  features. 

Malignant  Cholera,  the  name  that  at  present  may  be  adopted 
as  the  least  objectionable,  exhibits  very  distinctly  different  stadia 
or  periods,  each  possessing  its  peculiarities,  constituting  perfectly 
distinct,  and  in  some  of  them  dissimilar  states,  requiring  different 
modes  of  proceeding  in  the  treatment. 

Four  or  even  five  periods  may  be  distinguished,  and  will  be  best 
understood  by  treating  of  them  separately. 

A.    The  period  of  Predisposition  originating  in  the  Epidemic 
Influence  or  Constitution. 

Every  epidemic,  it  has  been  seen  in  our  genera!  observations, 
depends  on  the  agency  of  some  unknown  cause,  disposing  at  the 


"'^"TMtH^llnJTIp* 


22 

same  period,  numbers  of  individuals  on  whom  other  causes  per- 
turbative  oi  the  operations  of  their  economy  shall  exercise  their 
influence,  to  be  seized  with  a  particular  array  of  symptoms  or  at- 
tacks of  a  disease,  in  preference  to  any  other  set  of  symptoms  or 
disease  This  remote  cause  is  often  widely  diffusive,  acting  at 
once  over  a  wide  space.  It  gradually  advances  in  intensity, 
reaches  its  climax,  and  then  as  slowly  disappears. 

In  the  present  epidemic,  this  character  is  strikingly  displayed. 
Wherever  the  disease  has  prevailed  it  was  preceded  by  a  disorder- 
ed condition  of  the  g".3tric  and  intestinal  functions,  with  slightly 
aucmented  nervous  irritability.  And  during  its  continuance,  those 
who  escaped  the  explosion  of  the  disease,  all  suffered  in  varying 
degrees  from  affections  of  this  nature. 

In  Montreal  as  early  as  the  months  of  April  and  May,  this  epi- 
demic influence  was  manifested;  numerous  cases  of  stomach  and 
intestinal  diseases  attracted  the  attention  of  the  medical  practitioners. 
Cholera  Morbus,  though  out  of  season,  occasionally  occurred,  and 
one  fatal  case  with  the  symptoms  of  the  disease  thai  subsequently 
appeareJ,  took  place  in  the  Quebec  suburb,  under  the  care  of  Dr. 
Nelson,  on  the  2Sth  of  May. 

Dr.  Robinson  keeps  a  meteorological  table,  n  which  remarks 
are  made  on  the  prevailing  diseases  of  the  north.  He  exhibited  to 
us  the  following  entry  on  the  1st  day  of  May  last. 

At  St.  John's  the  same  facts  were  noticed.  JJr.  Buckley  lost  m 
Anril  a'patient  named  Steen  from  an  attack  of  Cholera  Morbus, 
which  exhibited  the  same  characters  as  the  epidemic  that  after- 
wards ensued,  ^  l      u 

In  Philadelphia,  every  one  the  I'^ast  observant,  has  been  con-  , 
srious  of  an  unusual  and  peculiar  ci  dition  of  his  economy,  during 
the  last  three  or  four  weeks,  chiefl  displayed  in  the  disordered 
state  of  the  stomach  and  bowels.  1  is  probably  no  exaggeration  to 
assert  that  two  thirds  of  our  population  have  experienced  feelings  of 
this  kind  This  derangement  of  the  functions  of  those  viscera,  is 
not  conflncd  to  our  district  of  country.  Letters  from  inedical  gen- 
tlemen in  various  sections  of  Uie  country,  as  far  south  as  North  Caro- 
lina announce  the  existence  of  the  same  phenomena.  Of  the  fact 
of  a' general  epidemic  predisposition,  there  can  exist  no  manner  of 
doubt.  It  remains  then  to  inquire  1st,  the  symptoms  of  this  state, 
and  2d,  the  condition  of  organs  in  which  it  consists. 

1st.  Symptoms  of  the  Epidemic  Constitution. 

They  are  chiefly  disturbance  in  the  healthful  feeling  of  the 
stomach  nnd  bowels,  and  the  regular  exercise  of  their  offices. 
Digestion  is  impaired;  food  that  formerly  caused  no  disorder  of 
these  viscera,  produce  a  sense  of  tumefaction  and  distention  of  the 
stomach  and  abdomen,  or  bring  on  attacks  of  coh  diarrhoea. 

A  ser  timent  of  heat  in  the  belly  is  not  unusual,  ami  .ght  dysen- 
teric symptoms  are  present.  The  tongue  in  most  persons  is  fur- 
red, and  not  nnfrequently  pasty.  Thirst  is  generally  more  urgent 
than  usual. 


23 

This  array  of  symptoms  so  generally  experienced,  is  clearly 
indicative  that  the  epidemic  cause  or  influence  aflects  primarily 
and  principally  the  mur.ous  tissue  of  the  alimentary  canal.  It 
would  appear  to  be  its  starting  point. 

2d.  The  condition  or  mode  of  being  of  this  tissue  as  indieated 
by  the  symptoms,  is  that  of  an  extensive  irritation,  occupying  not 
a  single  zone  of  this  ext-^nded  surface,  but  its  whole  extent.  The 
phenomena  manifested  in  this  period  of  the  disease  have  the 
closest  analogy  to  the  phenomena  resulting  from  small  doses  of  an 
irritr.ting  or  drastic  cathartic,  not  sufficient  to  ensure  a  free  and 
copious  evacuation,  but  tormenting  the  bowels  with  their  irritating 
impression,  disturbing  their  offices,  and  worrying  with  irregular 
operations. 

The  treatment  adapted  to  this  period  and  to  these  symptoms, 
i"  chiefly  dietary.  While  the  symptoms  are  strongly  marked, 
solid  food  should  be  omitted.  Mutton  or  chicken  broth;  rice 
or  barley  water;  rice  or  hominy  for  a  few  days  should  constitute 
the  food.  Black  tea  made  by  boiling  so  as  to  form  a  strong  de- 
coction, possessing  slight  astringent  and  tonic  properties,  diluted 
with  cream  or  milk,  forms  the  l^est  breakfast  and  supper.  Bread 
should  be  stale.  At  the  same  time,  quiet  and  rest  should  be  ob- 
served. The  patient  should  keep  to  the  house,  or  remain  in  bed, 
and  maintain  the  body  in  a  comfortable  temperature,  erring  as  to 
heat  rather  than  cold. 

For  medicine  a  few  drops  of  spirits  of  camphor,  or  spirits  of 
camphor  with  laudanum  or  black  drops  (notwithstanding  the  for- 
mal prohibition  of  this  combination)  are  useful.  If  there  be  diarr- 
hoba  or  pain,  the  opiate  is  essential.  Calomel  or  blue  pill,  with 
opium  and  ipecac,  in  this  are  also  serviceable.  The  external  irri- 
tation of  the  skin  by  salt  or  by  foot  baths,  pitch  plaisters,  spine 
plaisters,  daily  frictions  of  the  body  are  exceedingly  serviceable, 
and  these  constitute  excellent  prophylatic  means. 

Purgative  medicine  must  be  avoided  entirely  in  the  delicate, 
feeble,  and  nervous,  and  in  the  robust,  strongly  constituted  and 
phlegmatic,  be  used  with  great  discretion  and  caution.  The  sa- 
line purgatives  are  particularly  obnoxious  to  this  complaint.  Many 
fatal  attacks  have  been  developed  by  them.  The  bowels  are  in- 
tolerant of  purgation. 

The  symptoms  of  this  state  are  easily  controulcd,  and  hence 
arise  the  numerous  remedies  extolled  as  specifics  in  Cholera. 
The  cures  have  been  in  cases  of  this  slight  nature,  apparently 
augmented,  by  timidity  of  character  in  some,  and  the  nervous  tem- 
perament of  others,  exaggerating  symptoms,  without  increasing 
their  danger. 

The  most  certain,  the  rrost  eflicicnt  remedies  are  diet,  rest  re- 
pose and  warmth. 

In  a  groat  majority  of  a  pojiulation,  the  epidemic  influence  pro- 
ceeds no  further  in  the  production  of  disease,  especially  in  the 
temperate,  and  those  of  good  constitution  ami  sound  organs.  To 
the  explosion  of  the  disease  in  its  aggravated  character,  an  exciting 
cause  is  necessary,  and  this  cause  may  be  any  circumstance  makine; 


24 

a  strong,  powerful  and  sudden  impression  on  the  economy,  no 
matter  what  may  be  its  nature.  Hence  it  is  that  all  situations 
where  unwholesome  and  offen.«ive  etHuvia,  exhalations,  miasmata, 
are  generated — where  malaria  exists — errors  of  diet,  passions, 
strong  doses  of  medicine,  and  a  thousand  other  circumstances  are 
observed  to  bring  on  sudden  attacks  of  the  disease. 

B.     The  Forming   Stage  or  Commencing  'Symptoms  of  the 

Disease. 


This  stage  or  period  varies  in  duration  from  a  few  hours  to  one 
or  two  days.  It  is  most  generally  induced  by  some  of  the  exciting 
causes  enumerated,  especially  errors  in  diet,  vicissitudes  of  the 
weather,  exposure  to  wet  and  cold,  and  fear. 

This  stage  is  to  be  considered,  1st,  as  to  the  organs  affected;  2d, 
the  condition  of  the  organs;  3d,  the  treatment. 

1st.  The  stomach  and  bowels  still  take  precedence,  as  is  evinced 
by  the  symptoms,  in  the  most  decided  manner.  The  stomach  is 
nauseated  and  vomiting  is  urgent.  The  discharge  from  the  stom- 
ach is  at  first  very  frequently  the  food  which  had  last  been  taken. 
Often  the  meals  of  the  last  twenty-four  hours  ai'e  rejected,  having 
remained  undigested.  The  general  character  of  the  fluid  evacuated 
is  a  clear  thin  fluid,  resembling  rice  water — it  is  sometimes  bili- 
ous or  greenish. 

Diarrhoea  is  a  very  constant,  though  not  universal  attendant. 
The  discharge  at  times  resembles  thick  gruel,  or  is  very  similar  to 
that  yielded  by  the  stomach- — often  ps  clear  nearly  as  spring  water, 
but  having  a  sediment  of  a  mucous  or  albuminous  character  set- 
tling after  standing.  Violent  tormina  often  exist,  sometimes  tenes- 
mus, with  spasms  of  the  stomach  and  intestines,  with  so  much  tor- 
ture to  the  suffering  patient  as  to  cause  him  to  scream  with  the 
agony  he  endures.  The  discharges  both  upwards  and  downwards 
in  this  period  are  mostly  of  two  kinds  and  usually  mixed  together. 
The  one  a  very  thin,  clear,  serous  fluid,  the  other  albuminous  mat- 
ter, either  in  flocculi,  or  the  form  of  a  white,  thick,  and  creamy 
fluid. 

In  this  stage  disorder  of  nervous  function  is  manifested.  Cramps 
affect  the  extremities,  most  commonly  commencing  in  the  feet  and 
attacking  the  muscles  of  the  legs,  then  the  thiglvs — the  upper  ex- 
tremities suffer,  and  in  very  desperate  cases  the  whole  body  is 
seized  with  spasm. 

Neuralgic  pains  or  morbid  sensibility  is  also  very  common.  In 
some  instances  they  prevail  in  a  most  excruciating  manner,  with- 
out the  slightest  contraction  of  the  muscles;  at  other  times  both  af- 
fections exist  together. 

The  glandular  secretory  apparatus  has  its  functions  deteriorated. 
Bile  is  not  secreted,  the  urine  is  deficient,  the  tears  are  dried  up. 
No  mental  emotion  calls  forth  this  natural  witness  of  the  internal 
grief  of  the  soul. 

The  circulation  in  this  stage  is  under  the  influence  of  the  morbid 


25 

condition.  The  general  circulation  or  that  of  supply  is  enfeebled — 
the  pulse  becoming  small,  frequent,  and  feeble.  The  organic  or 
capillary  circulation  presents  opposite  states.  The  surface  of  the 
body  loses  its  temperature,  the  extremities  begin  to  cool  and  to  di- 
minish in  bulk,  showing  the  moveable  element,  the  organic  fluid 
of  their  tissues,  is  forsaking  them.  The  head  in  the  same  manner 
has  a  diminished  temperature.  The  features  begin  to  shrink,  the 
eyes  look  hollow.  The  colour  of  the  whole  exterior  is  of  a  duller 
hue,  the  nails  and  lips  are  livid,  the  eyes  are  surrounded  with  a 
darkish  zone,  the  fingers,  hands,  and  feet  exhibit  a  lividity  that  is 
unnatural.  The  pulmonary  or  respiratory  organs  in  this  stage  ex- 
hibit signs  of  disorder.  The  breathing  is  anxious,  laboured,  oppress- 
ed, in  some  exceedingly  distressing. 

In  this  state  then  the  organs  affected  are  the  stomach  and  bowels, 
the  glandular  organs,  the  nervous  organs  of  muscular  contractility 
and  sensibility,  the  organs  of  the  general  circulation,  the  capillary 
vessels  of  the  external  surface,  and  the  respiratory  organs. 

2d.  The  condition  of  the  organs  is  to  be  determined  from  the 
symptoms  and  a  knowledge  of  their  functions.  The  symptoms  are 
the  outward  sign  or  manifestation  of  the  disturbance  in  the  natural 
function  or  condition  of  the  organ.  They  are  the  language  of  the 
suffering  organ.  The  natural  function  or  condition  must  first  be 
known  before  the  meaning  of  the  symptom  can  be  understood. 

The  symptoms  emanating  from  the  stomach  and  bowels  are  those 
of  a  most  wide  spread  and  most  active  irritation  of  the  gastro-in- 
testinal  mucous  tissue.     It  is  not  a  single  compartment  of  this  ex- 
tensive surface,  greater  than  that  of  the  whole  exterior,  that  is  af- 
fected, but  every  point  is  involved  at  the  same  moment.     Hence 
the  simultaneous  discharge  upwards  and  downwards.  Neither  is  it 
one  element  of  this  complicated  tissue  which  is  the  subject  of  this 
morbific  impression  and  suffers  in  its  mode  of  being.   The  capilla- 
ries are  highly  injected,  as  shown  in  post  mortem  examinations, 
when  death  endues  in  a  few  hours,  and  previous  to  copious  dis- 
^.arges,  that  relieve  the  congested  organ.     The  exhalents  pour 
forth  a  copious  watery  or  serous  perspiration.     The  mucous  folli- 
cles and  cryptae,  and  the  glands  of  Peyer  and  Brunner  invariably 
enlarged,  and  in  protracted  cases  mostly  ulcered,  are  irritated,  in- 
flamed, and  furnish  the  vitiated  mucoid  secretion,  constituting  the 
whitish,    creamy,  and   albuminous  matter   discharged  from    the 
bowels  and  found  in  them  so  constantly  after  death.    The  nervous 
expansion  or  tissue  forming  an  element  of  this  membrane  experi- 
ences a  violent  irritation,  provoking  the  contractions  of  the  muscu- 
lar tunic.  Hence  the  spasms,  tormina  and  griping  pains  so  frequent- 
ly torturing  the  patient  with  agonizing  sufferings. 

The  condition  of  the  nervous  organs,  giving  rise  to  the  cramps, 
spasms,  and  neuralgic  pains,  it  is  not  easy  to  deternjine.  These 
symptoms  have  their  origin  in  the  columns  of  the  spinal  marrow, 
but  the  precise  pathological  state  of  this  structure  is  very  obscure. 
Dissections  do  not  demonstrate  any  remarkable  alterations  of 
structure,  nor  is  the  coloration  so  generally  affected,  or  injection  of 
vessel  frequent,  as  to  lead  to  a  supposition  of  any  very  intense  ac- 

4 


h 


26 

tion  liaving  existed.  Besides,  the  cramps  and  spasms  in  most  cases 
are  a  symptom  so  easily  controlled,  that  they  cannot  be  consi- 
dered a  very  important  feature  of  the  pathological  state.  A  tour- 
niquet, a  tight  ligature,  cups  to  the  spine,  or  even  to  the  abdo- 
men, frictions,  are  often  suflicient  permanently  to  dissipate  and 
almost  always  to  relieve  them.  Tiic  sutfcring  of  the  patient  is  then 
abated,  but  no  material  improvement  is  elFected  in  his  condition. 
The  neuralgic  pains  often  yield  to  frictions  or  cups  on  the  spine, 
or  to  a  few  drops  of  laudanum,  without,  however,  the  patient  be- 
ing placed  in  a  less  hazardous  position. 

From  the  symptoms  it  is  evident  there  is  disorder  of  the  ner- 
vous functions  of  sensibility  and  muscular  motility.  But  we  find 
these  functions  to  manifest  disorder  under  two  opposite  conditions — 
an  inflammatory  excitement  of  the  nervous  organs;  and  the  reverse 
— or  a  state  of  exhaustion,  especially  induced  by  excessive  losses  of 
blood,  or  by  copious  evacuations.  From  either  of  these  causes 
will  proceed  neuralgic  pains,  spasms,  and  even  convulsions.  The 
cerebral  organs  remain  unaffected,  or  at  least  exhibit  no  disorder 
or  commotion.  They  are  enfeebled,  and  every  exertion  of  the  mind 
is  an  effort  frequently  painful  to  the  patient.  There  is  want  of 
energy  in  the  actions  of  this  structure. 

The  glandular  apparatus  appears  to  suffer  from  deficiency  in 
its  circulating  fluid,  and  a  want  of  excitement.  In  this  respect  it 
is  in  unison  with  the  skin. 

The  condition  of  the  heart,  the  impelling  force  of  the  general 
circulation,  is  that  of  gradually  increasing  debilitation .  The  gene- 
ral circulation,  or  the  system  of  supply  to  the  capillary  or  organic 
circulation,  is  becoming  exhausted,  being  deprived  of  a  large 
amount  of  the  quantity  of  blood  it  contains  and  circulates  From 
these  states  the  pulse  loses  in  its  force  and  fulness,  while  it  pos- 
sesses augmented  frequency;  and  the  blood  is  not  propelled  in 
sufficient  quantity  into  the  organs  unaffected  by  the  diseased  con- 
dition to  sustain  and  develop  their  forces  of  life. 

The  capillary  circulation,  in  which  in  health,  antagonizing  forces 
preserve  an  equilibrium,  exhibits  t,hc  commencement  of  the  com- 
plete overthrow  it  subsequently  manifests.  The  extremities,  es- 
pecially the  lower  extremities,  lose  their  natural  temperature; 
beneath  the  nails,  the  colour  is  seen  purple,  livid  or  blue.  This 
change  in  the  coloration  extends  gradually  along  the  limbs,  and  is 
seen  to  circle  the  mouth  and  the  eyes.  Now  commences  the 
shrivelling  of  the  fingers,  hands,  toes,  and  feet.  The  skin  loses 
its  elasticity,  and  remains  in  whatever  position  it  may  be  drawn. 
These  changes  are  the  evidence  of  three  positive  conditions:  1st, 
the  moveable  element  of  the  organism,  the  sanguineous  fluid,  exists 
in  the  exterior  surface,  in  much  less  proportion  than  is  natural;  it 
has  abandoned  the  periphery  of  the  body:  2nd,  the  red  globules 
remain  stagnant  in  large  quantity  in  the  tissues,  their  movements 
have  ceased,  and  hence  they  acquire,  as  they  always  do  when 
quiescent  and  not  exposed  to  the  action  of  the  atmospheric  air  or 
oxygen,  the  dark  hue  of  venous  blood:  3d,  the  watery,  serous, 
valine,  and  albuminous  elements  of  thu  blood  have  escaped  from  the 


.^. 


27 


i^*« 


internal  and  external  surfaces,  so  as  to  change  materially  the  cha- 
racter or  constitution  of  the  sanguine  vital  fluid.  The  red  globules 
can  move  only  from  the  pressure  of  the  watery  element,  the  ve- 
hicle which  gives  them  mobility.  The  loss  of  this  tends  to  the 
general  stasis  of  the  circulation  that  is  to  be  observed  in  every  por- 
tion of  the  structure.  The  internal  capillaries  exhibit  a  condi- 
tion the  reverse  of  the  preceding.  The  blood  that  has  abandoned 
the  exterior  is  precipitated  into  the  tissues  of  the  interior,  is  accu- 
mulated and  detained  in  them,  forming  an  extensive  congestion 
with  hemastasis  or  stagnation  of  the  blood.  An  examination  of  the 
interior  surfaces  open  to  inspection,  demonstrates  this  state  to  exist. 
By  turning  down  the  lower  lip,  exposing  its  inner  surface,  the 
vessels,  capillaries,  and  the  whole  tissue  are  seen  injected  with 
blood  in  the  most  beautiful  manner.  In  the  advanced  period,  or 
collapse,  it  has  the  appearance  of  a  fine  size  injected  preparation, 
and  when  pressed  on  with  force  by  the  finger,  the  blood  is  not 
displaced — the  stasis  is  complete. 

The  respiratory  organs  in  this  stage,  do  not  present  aberrations 
strikingly  indicative  of  their  pathological  condition.     The  huski- 
ness  or  thickness  of  the  voice,  resembling  that  caused  by  a  slight 
cold,  and  the  anhelation  with  a  sense  of  oppression  in  the  chest, 
arise  from  a  commencing   alteration    in  the  laryngeal,  tracheal, 
and  bronchial  mucous  membrane,  and  probably  a  disorder  in  the 
functions  of  the  pneumogastric  and  thoracic  ganglia.    The  natural 
secretion  of  mucus,  lubrefying,  and  softening  the  membrane,  and  fit- 
ting it  for  its  various  offices,  is  arrested.     Its  circulation  is  be- 
coming embp'-rassed  and  congested,  of  which  the  aspect  of  the 
labial  surface   and  gums  is  an  indication   and   evidence.     From 
this  state  of  the  mucous  membrane,  the  voice  is  affected  some- 
what as  it  is  from  an  analogous  condition  in  irritation  of  this  tissue 
from  cold.     The  function  of  respiration,  attached  to  the  bronchial 
mucous  membrane,  is  necessarily  affected  by  the  stasis  or  remora 
which  occurs  in  its  ci. .  ulation  and  its  power  of  transmitting  the 
blood.     Hence  the  feeling  of  sense  of  suffocation,  of  the  want 
of  air,  a  feeling  always  called  into  existence  whenever  the  mass 
of  the  blood,  from  any   cause  whatever,  does   not  undergo  the 
changes  essential  to  its  consitution,  by  an  exposure  to  the  air  in 
the  lungs.     The  difficulty  experienced  in  the  circulation  of  this 
membrane,  resists  and  prevents  the  passage   of  the  blood   from 
the  heart,   and   that  fluid  accumulates  in  the  pulmonic  ventricle 
and   auricle,    and    the    venous    system    generally.     This   is   the 
correct   explanation  of  the  anhelation   and  oppressed  breathinjrT 
the  anxiety  and  sense  of  suffocation  experienced  by  the  patient; 
it  is  from  this  cause  also  that  proceeds  the  praecordial  anguish  so 
often  endured  by  the  suO'erer  from  this  disease,  and  the  accumula- 
tion of  blood  found  after  death  in  the  right  or  pulmonic  cavities  of 
the  heart  and  general  venous  system. 

That  the  above  symptoms  depend  on  the  causes  assigned,  and  are 
not  connected  with  a  congestion  of  blood  in  the  lungs  is  evident. 
1st,  The  chest  when  percussed  is  resonant;  2d,  examined  with  the 
stethoscope,  the  resiparation  is  clear,  distinct,  and  uninterrupted; 
3d,  after  death  when  the  chest  is  opened,  the  lungs  collapse,  or  if 


2S 

they  do  not,  they  are  emphysematous,  and  are  remarkably  devoid 
of  blood;  4th,  the  bronchial  and  tracheal  mucous  membrane  is  red, 
turgul,  and  congested;  5th,  when  reaction  ensues  after  the  collapse, 
a  sullocating  bronchitis  occasionally  succeeds  and  destroys  the  pa- 
tient in  a  few  hours. 

The  general  pathology  of  this  stage  of  the  disease,  as  deduced 
Ironi  the  combination  of  the  especial  pathology  of  the  different  or- 
gans, may  be  stated  as  the  following:  1st,  an  active  irritation  over- 
powonng  the  whole  extent,  and  involving  every  constituent  of  the 
alimentary  mucous  tissue,  giving  it  a  predominance  over  the  vital 
energies  of  every  other  organ  of  the  economy,  and  directing  on  it, 
by  a  movement  of  concentration,  the  mass  of  the  organic  or  capil- 
lary circulating  fluid:  2d,  profuse  and  exiiausting  evacuations  of  the 
serous,  watery,  and  albuminous  constituents  of  the  blood  escaping 
Iromthc  internal,  and  leaking  from  the  external  dermoid  membrane 
at  every  pore;  3d,  debilitation  or  enfeeblement  of  the  action  of  the 
heart,  and  exhaustion  of  the  general  circulation;  4th,  irregularitv 
and  disorder  of  the  nervous  excitation  of  muscular  contraction  and 
of  sensibility;  5th,  suspension  of  the  glandular  secretions;  6th,  a 
commencing  stasis  or  stagnation  of  the  organic  circulation,  and  the 
consequent  i)iesence  of  the  lethal  fluid— black  or  unoxygenated 
blood,  in  all  the  vital  organs— the  beginning  of  asphyxia;  the  gra- 
dual accumulation  of  the  circulating  fluid,   and  its  arrest  in  the 
venous  system  and  pulmonic  heart. 

3d.  The  indications  of  a  method  of  treatment  founded  on  the 
pathology  of  this  state,  are  apparent.     They  consist  1st,  in  dimi- 
nishing the  irritative  excitement  of  the  alimentary  mucous  tissue; 
2d,  in  causing  revulsion  in  the  movement  of  the  circulating  fluid 
by  the  irradiation  of  irritation  from  the  internal  gastro-intestinal 
tissue  to  the  heart,  lungs,  brain,  and  skin,  or  its  general  diffusion 
throughout  the  economy,  exciting  by  this  means  into  activity  the 
diminished  energy  of  the  capillary  or  organic  circulation,  and  sus- 
taining the  failing  i^alance  in  the  powers  of  the  organs;  3d,  in 
allaying  the  increased  irritability  of  the  gastro-intestinal  mucous 
membrane,  and  restoring  the  nervous  excitement  to  its  natural 
state;   4th,  in   exciting  the  suspended  glandular  secretions,   and 
imparting  to  them  a  healthful  character.     These  different  indica- 
tions may  bo  fulfilled  by  a  variety  of  means  and  numerous  reme- 
dies.    Hence  it  is,  that  so  many  methods  of  treatment  and  diffr-r- 
ent  reniedies  have  been  extolled  as  surperlative  in  the  treatment 
of  malignant  Cholera,  and  alone  to  be  relied  on  according  as  some 
one  has  been  exclusively  pursued.     The  best  general  method  can 
be  determined  only  by  a  very  laboured  and  judicious  comparison 
under  the  same  circumstances  of  different  systems  of  treatment. 
But  this  task  has  not  been  accomplished.     Besides,  no  one  method 
can   be  adapted  to  every  individual,  regardless  of  constitution, 
habits  of  life,  temperament,  moral  disposition  and  previous  health 
of  the  patient.     These  circumstances  modify  the  individual,  mak- 
ing one  person  different  from  another.     The  strong,  robust,  health- 
fully constituted,  are  to  be  managed  differently  from  the  feeble, 
the  frail  and  sickly;  tin-  inleniperate  are  distinct  beings  from  the 


a9 

temperate.  The  sanguine,  lymphatic  or  nervous  temperaments 
demand  modifications  in  treatment.  The  calm,  collected,  and 
couraceous,  present  symptoms  of  a  different  character  from  the 
timid,  acitato.l  and  fearful,  and  very  opposite  courses  are  to  be 
pursued  with  respect  to  tiicse  individuals.  It  is  the  physician  ot 
knowledge,  tact,  and  judgment,  that  makes  these  discriminations, 
and  regulates  his  proc'-edings  in  conformity  to  them. 

When  the  symptoms  of  this  stage  are  severe,  the  cramps  and 
spasms  violent,  with  urgent  vomiting  and  dejections,  if  the  patient 
be  of  sober  habits,  sang  line,  roliust,  and  plethoric,  the  most  prompt, 
decided,  and  certain  remedy  is  the  abstraction  of  blood  from  the 
general  circulation.  Ten,  fifteen,  or  twenty-five  ounces  may  be 
drawn  according  to  circumstances.  This  remedy  allays  immedi- 
ately the  excitive  irritation  of  the  digestive  intestinal  apparatus, 
and  operates  a  revulsion  from  the  interior  surfaces  where  conges- 
tion is  forming.  It  may  be  followed  up  with  great  advantage  by 
local  depletion,  effected  by  cups  or  leeches  applied  to  the  abdc 
men,  or  in  some  cases  to  the  anus. 

In  those  of  the  nervous  temperament,  the  habitually  intemperate, 
the  feeble  and  delicate,  local  depletion  by  cups  or  leeches  fiom  the 
epigatlrium,  the  prajcordia,  or  anus,  is  to  be  preferred  to  general 

depletion.  .       ,     , 

In  iiie  lighter  forms  of  this  stage  of  the  disease,  sanguine  deple- 
tion is  not  necessary,  but,  whenever  the  symptoms  are  of  aggra- 
vated character,  threatening  to  advance  into  the  collapse,  according 
to  the  circumstances  of  the  case,  one  or  the  other  mode  ot  deple- 
tion is  imperative.  It  places  the  patient,  most  generally  in  saiety, 
and  prepares  his  economy  for  the  more  prompt  and  elhcacious 
operation  of  other  remedies. 

Subsequent  to  depletion  the  remedial  means  accomplishing  the 
other  indications  are  to  be  immediately  brought  into  requisition. 
Stimulant  pediluvia  are  of  great  utility;  the  feet  to  be  wrapped  up 
after  the  bath  in  warm  flannel;  either  frictions,  wif;.  decoctions  ot 
Cayenne,  or  some  some  stimulant  liniment  or  ointment;  dry  Iric- 
tions;  lotions  or  epithems  of  spirits  of  camphor,  or  plaisters  ot  spice 
to  the  abdomen;  sinapisms  to  the  abdomen,  to  the  extremities,  and 
to  the  chest,  are  means  all  acting  on  one  principle,  and  -  ^ 
one  or  more  of  them  should  be  employed.  ,  ,       ,  ,        , 

While  the  diffusion  of  excitement  is  attempted  by  the  external 
means  enumerated,  the  same  object  is  to  be  attained  by  various 
internal  remedies.  The  alcoholic  solution  of  camphor,  camphor 
water;  calomel  and  opium;  blue  mass  opium  and  ipecacuanha;  sul- 
phuric either;  ammonia;  warm  brine;  spirits  of  lavender  compound; 
and  many  other  similar  medicines,  have  been,  and  are  constantly 
employed,  and  all  with  more  or  less  success,  as  they  happen  to  be 
administered  in  the  cases  adapted  to  their  exhibition.  Whenever 
the  condition  of  the  patient  admits  of  the  employment  of  diltusible 
excit-nt  agents,  and  diffusion  of  excitement  and  reaction  can  readily 
be  accomplished,  this  order  of  remedies  is  admissible  and  otten 
advantageous.  The  cases  in  which  these  means  are  most  service- 
able are  those  of  a  light  character,  in  which  the  nervous  tempera- 


>\ 


30 

ment  prevails  and  nervous  symptoms  are  mnsf  nr«  i      ■       . 

in  whicli  timidity  and  iVar  Invc  ^1,.^.?^      .'•""""'*"*'  ""^ 

toms  by  their  .lepressin«  [nlKu^.'cr        "^^'''''^'^^  ^°  ^'>«  ^y^ip- 

In  the  cases  where  sanguine  irritation  is  the  mnrn  l„    r       r 
ture,  they  are  not  safe  nMT)e,lies  unless  nreoodr  I  M  .''"\^  .'^''- 

In  cases  of  the  last  ciK.ractcr    e^    o'    ly        '     ^^ 
gu.ne  tem,,erament  and  robust    ndi'vid,  a  s     vi^     1    1  '  •'  'i'?' 

stomachs,  who  suffer  intense  ihirs  wi  1  1,  ,  '"^'''>^,  '['"'"'^'l'^ 
the  epigastrium,  i.e  held  in  the  mou  h  ced  v^.  ""'^  • '^'"*  °^ 
quantities,  the  ehoi  vescinir  drim    ^  ,  o'/  '  '''"''''"   '"  ''^'"•''" 

ferred  in  t'he  first  perio'  s If  il'  ^t  H ^'^^M^'f ?'  "7^"  ""'  ^'''- 
At  the  same  time  external     li    ula  ion  b    .. '  "'""'.  '''•^''»"^«- 

catcd,  is  to  he  actively  employed  ^      "  '"''''"'  ''^'^'^^^  ^"d'" 

ne:&i:;2!:,'!;SdS;.^d:Lurr^^r"^^ 

symptoms  may  be,  medical  advice  must  be  sonX  fn.       f     ^''"^ 
precaut  on  taken.     This  is  mnrn  nlT  ■  n     f°"Snt  for,  and  every 

the  sicldy,  the  aged      "dntlnerr'Tf '''"'  '''f'  ''''  ^'^^'^ 

by    ■  c  fir^t  onsa^f'the  dilTe  rstiled'  ^a^Tant'^C^^r 

C.   Co/^/  ^/flr^c,  or  State  of  Collapse. 

aS:  t:Sn^i^:^c:;'^::x:::^sE^!^L;^  p--^^-^- 

p  eted.  The  conservative  power  of  tVeeonsUtion''  "7  ''"" 
ed,  are  nullified.     The  balance  in  the  forces  of     1  ''^' 

ing  the  harniony,  and  compos  "'^  the  uSv  of  tl?.'^''"' '''"'^'^^ 
overthrown;  the  connexion  of  the^^or^ans  i  Jirscverer""^^'  ' 
t.on,  or  the  diflfusion  of  excitement  lirughout  U  o  Ses  "n  T''- 
cera,  by  which  they  lend  .  mutual  assistant  to  each  o  her  T 

to  be  accomplished,  anarchy  and  misrule  nde  trlnn,  /  '"'i'"'^ 
superb  fabric  lies  prostrate  in  ruin  tnumphant,  and  the 

The  period  when  this  stage  occurs  v.iries  ^■^con^A^,^  :         t     • 
dividuals  who  are  enfeebled  by  any  cJusTand  whi^  ^^     ^"  '"" 
incapable  of  opposing  a  resistance  to  Zmn  ^  °'S'"'  "'^ 

actions  establiZd,  it^omes  ^  vi  h 'foaXlt  ,  ""^ 

currence  most  frequently  is  observed  in  thnJ  ^i  ^'  ^''l?  °'^- 
from  chronic  inflLma^ons  of  t^e  digestirnn^nl"'  ?'^'''^^ 
gans;  in  the  int.-.perate,  who  are  us  fly^-^thi  st^'X"^  ''" 
ag,  and  those  exhausted  by  labour,  fatrgue,  and  aninnf  ritiS 

no  ^r  ^ii:-  ^x'  ::i^:-t^z  ^o?  ^:  r  ^-^°^- 

nounces  the  threatened  daneer   but  from  fK    /  ''"''''''''  ^"- 

the  cold  stage  or  collapseXie'cc^""  d  ^^.^^^  I!^?,'^!^^^   ^^.^"-k 
uent  in  a  lew  hours  into  eternity.  "  '      "^  '         '"*  ^^°  ^'^' 


31 

This  stage  may  be  divided  into  two  periods — the  incipient,  and 
the  confirmed,  or  state  of  asphyxia. 

The  incipient  cold  stiii^c  is  the  extreme  a}i;s;ravation  of  all  the 
symptoms,  and  tiie  j)allu)lojricul  conditions  of  the  ()rjj;ans,  described 
as  apporlaininu;  to  the  forming  stage.     The  evacuations  upwards 
and  downwards  aro  generally  freipient  and  copious,  consisting  of 
a  tiiin  scro-albuminous  iluid,  either  clear   or  of  various  colours. 
The  epigastrium,  in  most  instances,  is  exceedingly  sensitive  to  the 
touch;  i)urning  heat,  feeling  of  distension,  and  oft'Mi  violent  spas- 
modic pains  are  felt  in  the  abdon..'n.     The  thirst  is  intense,  the 
ton<ruc  is  cold,  moist,  and  mostly  pai.d — the  temperature  of  the 
breath  diminished — the  voice  reduced  to  a  whisper  and  is  guttural; 
the  external  surface  is  cold,  generally  hat'ied  in  a  colliiiualive  cold 
sweat,  yet  the  patient  complains  of  a  disiressing  sensation  of  heat, 
and  warmth  is  excessively  annoying;  the  skin  of  the  lingers,  hands, 
and  feet,  is  siuivelled,  and  its  elasticity  impaired.      The  extremi- 
ties of  the  fingers  and  even  hands  arc  discoloured,  having  a  livid 
or  blurish  tinge.      The  capillary  circulation  is  feeble,   the  blood 
pressed  from  the  skin  and  inner  labial  surface  returning  with  slow- 
ness.    The  pulse  is  feeble,  vanishing  from  the  touch — generally 
frequent.     A  disposition  to  fainting  is  common.     The  respiration 
is  oppressed,  the  sense  of  suffocation  distressing,  with  often  great 
precordial  anguish.      The  face  is  pallid,  the  eyes  surrounded  with 
a  livid  areola  and  are  sunken;  the  features  pinched  and  shrivelled 
— all  the  phenomena  of  extreme  old  age  are  induced  in  a  few  hours 
— the  spasmodic  cramps  and  neuralgic  pains,  sometimes  one,  some- 
times the  other,  and  frequently  both,  are  generallj'  present,  and 
often  subject  the  patient  to  extrcmq  anguish.      They  are  less  fre- 
quent and  more  easily  controlled  in  the  phlegmatic  or  lymphatie 
than  the  nervous  temperament.  . 

The  incipient  collapse,  in  individuals  of  robust  constitution,  who 
have  enjoyed  good  licalth,  and  led  temperate  lives,  in  whom  the 
attack  has  not  been  induced  by  some  most  gross  act  of  imprudence, 
is  very  frequently  arrested,  and  reaction  is  established.  But,  in 
the  feeble,  the  intemperate,  the  aged,  the  broken  down  valetudi- 
narian, those  exhausted  by  fatigue  and  watching,  it  resists  all  re- 
medial means,  and  hastens  with  unrestrained  rapidity  into  the  se- 
cond period,  confirmed  collapse  or  state  of  asphyxia. 

In  the  confirmed  collapse  all  hope  has  fled — so  few  are  the  es- 
capes froiii  this  condition,  it  may  be  regarded  as  the  dying  state. 
The  symptoms  of  the  anteceding  period  have  reached  their  climax. 
The  evacuations  are  less  constant  in  this  period;  at  times  they  con- 
tinue f  refuse,  but  often  cease  or  arc  easily  checked.  The  torment  of 
thirst  is  unabated — cold  drink  is  ardently  desired  and  vehemently 
demanded — tongue  and  breath  cold,  ihe  voice  almost  extinct. 
The  surface  cold  as  marble,  is  bedewed  with  a  clear,  thin  fluid 
strained  through  every  pore.  A  sense  of  oppressive  heat  still  pre- 
vails, and  the  application  of  warmth  is  earnestly  resisted;  it  causes 
restlessness,  and  frequently  violent  efforts  to  escape  from  it,  ex- 
hausting and  injuring  the  patient.  The  sensibility  of  the  skin  in 
this  as  in  the  preceding  period,  is  often  morbidly  acute— sinapisms 


n 


and  other  irritating  remedies  cannot  be  borne;  they  cause,  Gome- 
tTmcs  in  a  few  minutes,  intolerable  pain-vesication  is  easily  in- 
duced Actions  with  decoction  of  cantharides  will  often  remove 
[hevvholc  cuticle-spontaneous  vesication  of  the  face  has  occurred 

'"The  Hvid  and  bluish  tinge  of  the  extremities  now  pervades  the 
whoie  body,  passing  frequently  into  a  sooty  hue.  The  same  co- 
lour is  seen  a  ound  the  cj  cs,  and  in  the  internal  surface  of  the 
mouth  and  lips.  The  eyes  are  sunken  deep  in  their  sockets  with 
Hh  stly  exm-ession,  or  are  rolled  upwards  in  their  orbits_at  his 
peHo  1  the  adnata  a're  often  injected.  The  mind  is  enfeeb  ed 
nuestions  harrass  and  worry  the  patient;  the^efforts  at  conversation 
r  exhaling-he  becomes  listless,  indifferent,  careless  to  h.s 
fate  and  even  invites  death  as  a  relief  to  his  misery. 

The  pulse  is  either  scarcely  perceptible,  a  mere  thread  at  the 
wrst  or  i  has  vanished,  not  being  felt  even  at  the  axilla,  and 
TareW  to  be  detected  in  the  carotids.  The  capillary  circulation 
IS  now  nearly  terminated-no  impression  can  be  made  on  it  by 
pressure  on  L  labial  surface  where  it  can  be  brought  into  view, 

""'The  tasms  of  the  muscles,  in  this  as  the  other  periods,  are  not 
a  constant  phenomenon-in  many  instances  they  are  not  present, 
while  in  others  they  continue  to  torture  the  patient  to  the  last  mo- 
ment of  ex  tence;  and  after  death,  it  is  not  uncommon,  to  see  the 
fingers,  toet  and  at  times  the  limbs  move,  for  a  considerable 
npriod  from  the  contraction  of  the  muscles. 

^ShoJt^^  before  dissolution,  the  body  which  has  impressed  the 
touch  with  a  sense  of  cokhess,  generally  becomes  warmer,  and  a 
rnera7elow  appears  to  be  returning  to  the  surface.  1  his  pheno- 
Sn  often  l?ads  the  observer  into  a  belief  that  reaction  is  about 
t^  be  estabUshed-it  is  a  delusion-it  is  the  precursor  to  death,  and 
Ifter  dTssolu  ion  the  temperature  of  the  corpse  continues  to  aug- 
ment for  som 'time,  and  is  found  several  hours  subsequent     warmer 

%\ettl^dogy  or  the  condition  of  the  organs  of  the  cold  stage, 
does  not  differ  from  that  of  the  preceding  stages  except  in  degree. 
It  is  analogou  to  the  cold  stage  of  all  febrile  diseases  and  diseases 
of  Trritation.  It  bears  a  strong  resemblance  to  the  Pernicious  Algid 
Jntermi  en  ,  the  Cold  PlagSe,  as  it  is  termed  in  the  southern 
states  The  difference  betwien  the  cold  stage  of  this  and  other 
d^^eases  ar'ses  from  the  extensive  surface,  the  seat  of  the  primitive 
affection,  and  the  excessive  evacuation,  both  which  disable  the 
economy  ancfprostrate  its  forces  of  life  to  such  a  degree,  as  to  pre- 
vent effectually  reaction  from  occurring-and  death  necessarily 
Insues  as  it  does  in  the  cold  stage  of  pernicious  intermittent,  or 
^n^Ssease  when  reaction  or  diffusion-irradiation  into  the  whole 

"  T^irr  ThSTcff  of  treatment  in  this,  are  the  same 
as  i^'he'rTceding  stages,  but  with  much  less  Fospect  of^a  - 
cessful  issue.     Th^y  are  to  allay   h^^i^^^^^^ 
apparatus,  crcuic  aiiu  cninu-e  k.m-.i„!!i-     > 


"4tMi^4«iaK 


33 


se,  Dome- 

jasily  in- 

i  remove 

occurred 

'adea  the 
same  co- 
:e  of  the 
kets  with 
3 — at  this 
nfeebled, 
iversation 
!S3  to  his 

ad  at  the 
xilla,  and 
irculation 
on  it  by 
ato  view, 

s,  are  not 
;  present, 
e  last  mo- 
to  see  the 
nsiderable 

•esscd  the 
ner,  and  a 
lis  pheno- 
n  is  about 
death,  and 
IS  to  aug- 
warmer 

:old  stage, 
n  degree, 
d  diseases 
ious  Algid 
!  southern 
and  other 
;  primitive 
lisable  the 
,  as  to  pre- 
lecessarily 
littent,  or 
the  whole 

e  the  same 

of  a  suc- 

alimentary 

he  profuse 


discharges  from  the  external  and  internal  surfaces.  It  is  in  the 
first  period  of  this  stage,  or  incipient  collapse,  that  any  well  found- 
ed expectation  of  attaining  these  objects  can  be  indulged. 

General  bloodletting,  which  in  the  forming  stage  proves  the 
most  prompt  and  efficient  of  remedial  means,  becomes  in  this  stage 
an  uncertain  remedy,  exceedingly  equivocal  in  its  effects.  It  is 
decidedly  mischievous  in  the  intemperate,  the  feeble,  the  nervous. 
Abstracting  blood  from  the  general  circulation,  the  exhaustion  of 
which  is  one  of  the  strong  features  of  this  stage,  its  direct  opera- 
tion is  to  debilitate  and  enfeeble  the  actions  of  every  organ,  the 
healthy  as  wall  as  the  diseased — diffusion  or  reaction  is  then  ren- 
dered still  more  difficult,  if  not  impracticable. 

Local  depletion  by  leeches  to  the  epigastrium  and  lower  belly, 
to  the  anus,  and,  by  cups  to  the  abdomen  and  precordium,  may  be 
used  in  the  incipient  period  with  good  effect. 

From  the  coldness  of  the  general  surface,  application  of  warmth 
would  appear  to  be  decidedly  indicated — yet  experience  in  this 
city  has  not  shown  it  to  be  materially  beneficial — it  should  be  re- 
gulated to  the  feelings  of  the  patient.  Extreme  warmth  is  gene- 
rally prejudicial;  it  occasions  great  distress  to  the  patient  and  forces 
him  often  to  violent  exertions  to  escape  from  its  application — it 
favours  also  the  excessive  drainage  from  the  skin.  Heated  bran 
or  oats  in  bags,  is  the  most  preferable  mode  of  applying  warmth. 
The  excitement  of  the  skin  is  a  measure  of  importance.  Various 
modes  of  effecting  this  are  employed.  Dry  frictions  are  preferred 
by  some — others  employ  stimulant  embrocations,  liniments  or 
ointments.  Sinapisms  are  commonly  resorted  to.  Frictions  with 
tincture  or  terebinthinate  decoction  of  cantharides  are  recommend- 
ed, but  they  denude  the  surface,  by  removing  the  cuticle,  and  are 
objectionable.  This  effect  has  been  produced  by  frictions  with 
spirits  of  camphor. — Spirits  of  camphor,  heated  and  applied  to 
the  abdomen  and  to  the  limbs,  which  subsequently  are  covered 
with  flannels  imbued  in  the  same  liquid,  has  been  employed.  In 
the  incipient  collapse,  when  there  are  violent  pains  in  the  belly, 
warm  poultices  and  epithems  of  hops,  &c.,  and  stomach  warmers 
have  proved  highly  serviceable. 

The  internal  remedies  are  exceedingly  various.  They  gene- 
rally consist  in  excitants  more  or  less  diffusible.  Some  prefer  the 
very  diffusible  as  spirits  of  camphor — sulphuric  Eether — Hoffman's 
andoyne — tincture  of  opium — essence  of  menlh. — warm  toddy 
— others  rely  on  caiw..-.'.  alone,  or  with  opium,  or  blue  pill 
and  opium:  ammonia  and  carbon  of  ammonia,  camphor,  and  cayenne 
pepper  are  resorted  to.  Water  as  hot  as  it  can  be  swallowed,  has 
been  extolled.  It  is  useful  when  there  are  violent  spasms  of  the 
stomach.  Amongst  other  remedies  of  this  character  are  warm 
brine,  and  the  saline  solution  of  Dr.  Stevens — consisting  of  super 
carbonate  soda  >  dr.  muriate  of  soda,  1  scru.  chlorate  potass  gr.  vii. 
dissolved  in  half  a  tumbler  of  water  and  given  every  hour.  Fric- 
tions, dry  heat,  sinapisms,  and  injections  of  hot  brine  are  em- 
ployed at  the  same  lime. 

While  excitants  of  various  kinds  are  administered  by  some,  others 


i 


\\  \ 


34 

.  employ  sedative  internal  means— such  as  ice  in  small  quantities, 
or  held  in  the  mouth;  iced  gum  water;  the  effervescing  draught 
alone,  or  with  laudanum  and  camphor,  carbonated  water,  and  ace- 
tate of  lead. 

From  the  number  and  diversity  of  these  means,  for  all  of  which 
some  success  is  claimed,  it  is  evident,  that  no  one  course  of  pro- 
ceeding can  be  adopted,  to  the  exclusion  of  all  others.  Individual 
differences,  arising  out  of  habits  of  life,  constitution,  temperament, 
and  other  circumstances,  must  have  weighty  influence  in  directing 
the  course  of  the  practitioner.  The  stimulant  and  excitant  plan,  is 
adapted  to  the  intemperate,  the  feeble  and  the  \  ery  nervous.  The 
sedative  to  the  sanguine,  robust,  and  healthily  constituted.  In 
many  the  two  may  be  conjoined,  or  the  sedative,  proper  at  the  com- 
mencement, must  soon  be  abandoned  for  the  excitant. 

When  the  discharges  are  very  copious  they  should  be  arrested 
if  possible,  for  the  loss  of  the  aqueous  portion  of  tie  blood,  so 
changes  its  constitution  and  qualities,  as  to  become  a  new  source 
of  difficulty  and  danger.  It  confirms  the  arrest  of  the  capillary  or 
organic  circulation,  as  the  red  globules  cannot  move  when  de- 
prived of  their  vehicle.  Mild  astringent  decoctions  are  used  for 
this  purpose.  The  acetate  of  lead,  in  injections  in  the  dose  of  one 
sci'iple,  with  or  without  laudanum,  according  as  pain  has  existed  or 
been  absent,  has  been  effectual  for  this  ooject.  The  hot  brine  and 
saline  solution,  given  by  the  mouth  and  as  injections,  appear  to  act 
in  this  manner,  and  also  to  prove  mildly  stimulant  from  their  ab- 
sorption. 

Injections  in  to  the  veins  of  warm  water,  or  saline  solutions,  have 
been  proposed,  and  would  appear  to  be  the  most  direct  means  of 
meeting  this  last  indication.     Experience  has,  however,  shown, 
that  although  they  do  act  in  this  mode,  and  relieve  temporarily, 
yet  no  permanent  advantage  has  been  derived  from  them. 

D.  Stage  of  Reaction  or  Febrile  Period. 

When  the  patient  escapes  from  the  cold  stage  or  collapse,  a  re- 
action succeeds,  that  exposes  him  to  new  dangers  and  creates  new 
difficulties  to  the  practitioner. 

The  reaction  does  not  always  present  the  same  phenomena.  It 
varies,  1st,  in  being  confined  to  a  single  organ;  2d,  in  being  ex- 
tended to  the  whole  economy. 

In  the  first  class  of  cases,  the  brain  becomes  most  generally  in- 
volved, or  in  some  instances  the  lungs. 

The  reaction  of  the  brain  is,  at  times,  rapid  and  intense,  tbe 
syrnptoms  of  apoplexy  suddenly  supervening  and  destroying  the 
patient.  At  other  times  it  is  slower  and  less  vehement.  The 
head  becomes  warm,  and  is  of  more  elevated  temperature  than  the 
rest  of  the  body;  the  cheeks  and  lips  acquire  a  better  hue,  the  mind 
wanders  witii  a  light  delirium,  the  conjunctiva  are  injected  with 
blood.  The  affection  of  the  brain  increases,  pain  is  suffered,  often 
acute,  causing  the  patient  to  cry  out;  phrenitic  delirium  supervenes, 
wliicli  13  soon  succeeded  by  stupor,  profound  coma,  and  death. 


■^ 


35 

The  reaction  in  other  cases,  occupies  the  lungs;  the  respiration 
is  hurried  and  embarrassed;  the  pulse  rises,  becomes  full— the  skin 
warm;  when  the  chest  is  examined  with  the  stethoscope,  mucous, 
and  su'bmucous  rattles  are  heard,  the  patient  seeks  an  erect  position, 
and  soon  perishes,  suffocated  by  effusion  into  the  bronchial  tubes, 
or  with  pulmonary  engorgement.  .     ,.«•      j     •.  • 

?n  the  second  class  of  cases  the  reaction  is  dittused;  it  is  not 
manifested  in  a  single  organ,  and  assumes  the  type  of  the  ordinary 
typhoid  fevers,  too  familiar  to  most  practitioners  to  require  any 

particular  description.  ,         ,  ,-        c 

When  the  signs  of  the  first  class  of  cases  appear,  or  reaction  ot 
the  brain  or  lungs,  local  depletion  should  be  immediately  resorted 
to  by  leeches,  applied  behind  the  ears,  or  along  the  jugulars;  cold 
applications  should  be  made  to  the  head,  and  these  succeeded  by 
blisters  to  the  scalp.  When  the  symptoms  are  pulmonic,  cups,  or 
leeches  to  the  chest,  followed  by  blisters,  are  demanded.  In  some 
instances,  when  the  pulse  will  admit  of  it,  general  depletion  is  to 

be  resorted  to.  ^         .      .     ,  ,,    ^ 

The  treatment  of  the  second  class  of  reaction  is  the  same  as  that 
pursued  in  common  typhoid  fevers— having  great  caution  in  the 
employment  of  all  excitant  remedies. 

The  foregoing  general  statement  of  the  disease,  as  manifested  in 
the  different  organs  of  the  economy,  and  the  remedies  employed, 
is  not  intended  as  directions  to  the  general  reader  for  the  manage- 
ment of  the  disease— hone  but  professional  men  are  capable  of  un- 
dertaking this  task.  The  varieties  in  the  .ases  are  so  numerous, 
the  disease  is  modified  by  so  many  circumstances,  that  practical 
knowledge  and  skill  can  alone  enable  any  one  to  form  tl  ;  neces- 
sary discrimination.  This  portion  is  addressed  entirely  to  the 
professional  reader,  and  is  derived  from  the  personal  observations 
of  the  commission  on  the  disease  in  Canada,  New  York,  and  this 

^'^^''  SAMUEL  JACKSON,  M.  D. 

CHARLES  D.  MEIGs,  M.  D. 
RICHARD  HARLAN,  M.  D. 


The  following  report,  containing  a  general  summary  of  the  ob- 
servations of  the  Commission  on  the  characters  of  the  disease,  was 
submitted  to  the  Sanitary  Board,  the  day  after  the  return  of  the 
Commission,  and  was  then  made  public  through  the  Journals. 


Thf  Medical  Commission  appointed  by  tlie  Sanitary  Committee 
to  visit  Canada,  for  the  purpose  of  making  investigations  concern- 
ing the  epidemic  disease  prevailing  tlicro,  in  anUcipation  of  a  more 

dct 

d: 

th 

the  public  anxiety. 


nc  the  epidemic  disease  prevailing  there,  m  anticipation  ot  a  more 
Ictailed  report,  which  will  he  laid  before  the  Committee  in  a  few 
lavs  present  the  following  general  conclusions  as  the  result  oi 
ht-ir  observations,  whicli  they  (latter  themselves  will  tend  to  allay 


\ 


36 


1st.   The  disease  so 


1 


lately  an  epidemic  in  Montreal  and  Quebec, 
and  wliiVhVow  pTevails  in  tlie  city  of  New  York,  and  is  extend- 
ing throughout  tlie  country,  is  mahgnant  Cholera,  the  same  that 
has  ravaged  Asia,  and  spread  its  devastations  over  Europe,  under 
the  name  of  Asiatic  and  Spasmodic  Cholera. 

2d  That  they  have  not  been  able  to  ascertain  any  positive  un- 
equivocal  fact  to  justify  a  belief  that  it  is  u  disease  communicated 
bv  those  affected  with  it,  or  is  one  of  importation. 

3d  That  during  the  prevalence  of  the  epidemic  constitution  or 
influence,  a  general  predisposition  exists  in  the  whole  community, 
from  which  very  few  individuals  are  exempt,  productive  of  a  lia- 
bility to  the  disease.  ,  ,  ,  ,  , 
4th.  That  this  predisposition  is  manifested  by  embarrassed  and 
ditficult  digestion,  sense  of  heat,  fulness,  uneasiness  or  pain  in  the 
abdomen,  irregularity  of  bowels,  a  furred  and  pasty  tongue,  a 
sense  of  general  debility,  with  frequency  of  cramps  or  contractions 
in  the  muscles  of  the  extremities,  especially  at  night. 

5th.   That  this  state  of  predisposition  will  not  give  rise  to  an  at- 
tack of  the  disease,  without  the  application  of  an  exciting  cause. 

6th  That  the  exciting  causes  of  the  disease  a-e  moral  excite- 
ments, especially  from  the  passions  of  fear  and  anger;  intemperance 
in  the  use  of  fermented  and  spirituous  liquors,  or  in  eating,  over- 
loading the  stomach;  acid  drinks,  or  large  draughts  of  cold  water; 
the  use  of  crude  indigestible  food,  whether  animal  or  vegetable, 
particularly  the  latter;  excessive  exertion  or  fatigue  in  the  heat 
of  the  day;  exposure  to  the  night  air,  sitting  in  currents  of  air,  and 
particularly  skeping  with  too  light  a  covering,  and  with  the  wm- 
Sows  raised,  except  the  rooms  are  very  small  and  confined.  Most 
of  the  attacks  occur  in  the  night,  from   11   or   12  o'clock,  to  3  or 

4  in  the  morning.  .  ,       •  •    i       \,-^u 

7th.  Tl-.at  prudence  in  living  during  the  epidemic  period,  which 
continues  from  six  weeks  to  three  months,  the  wearing  of  flannel, 
particularly  on  the  body,  keeping  the  feet  warm  ^n^  ^ry  ^he 
avoidance  of  improper  food  r.nd  drinks,  tranquillity  of  mind  and 
body,  are  almost  certain  guarantee,  against  the  assaults  of  the  dis- 
ease, and  c'isarm  the  pestilence  of  its  malignity. 

Sth.  That  the  disease,  when  abandoned  to  its  course,  passes 
through  difl-crent  stages,  in  all  of  which  it  is  easily  controlled,  ex- 
cept one-the  cold  stage,  or  period  of  collapse,  and  which  is  in  al- 
mist  every  instance  preceded  by  the  symptoms  ot  the  forming 
stage,  when  the  disease  is  arrested  with  laciltty. 

9th.  That  the  symptoms  of  this  forming  stage  should  be  gene- 
rally promulgated,  and  persons  instructed  of  the  necessity  of  an 
immediate  attention  to  them.  It  is  ignorance  in  this  respect 
amongst  the  labouring  and  lower  classes  of  society,  leading  to  indit- 
fcrence  and  inattention,  together  with  their  habits  ol  life,  that  plunge 
so  many  belonging  to  those  conditions,  in  the  desperate  situation 
so  frequently  met  with,  when  medical  aid  and  human  skill  are  ut- 
terlv  unavailing.  Tho-e  symptoms  are,  a  sudden  looseness  ot  tlie 
bowels,  the  discharge  becoming  thin,  watery  and  colourless  or 
whitish,  with  little  odour— vertigo  or  dizziness— nausea,  oppres- 


37 

sion,  pain  and  cramps  of  the  stomach,  with  retching  and  vomiting 
of  a  fluid  generally  resembling  dirty  rice  water,  attended  or  soon 
followed  by  cramps  of  the  extremities,  particularly  of  the  legs  and 
thighs. 

10th.  When  the  foregoing  symptoms  appear,  application  for 
remedial  assistance  must  be  made  immediately.  The  delay  of  an 
hour  may  usher  in  the  cold  stage,  or  period  of  exanimated  prostra- 
tion and  collapse,  from  which  it  is  almost  impossible  to  resuscitate 
the  expiring  energies  of  the  economy. 

11th.  That  every  preparation  should  be  made  by  the  public 
authorities,  in  anticipation  of  the  appearance  of  the  disease,  pro- 
viding the  means  of  treatment  for  those  who  cannot  command 
them,  so  that  aid  may  be  promptly  administered  to  all  the  moment 
of  attack.  These  means  are — a  number  of  small  hospitals,  or  houses 
of  reception,  in  various  parts  of  the  city;  stations  where  nurses, 
physicians,  and  students,  with  suitable  medicines,  and  apparatus, 
can  be  procured  in  the  night  without  delay;  the  evacuation  of 
certain  localities,  where  the  occurrenceof  numerous  cases  indicates 
a  pestiferous  influence,  and  the  furnishing  to  the  poor,  as  far  as 
practicable,  wholesome  and  nourishing  food. 

By  the  adoption  and  observance  of  the  foregoing  means  of  pre- 
caution and  prevention,  in  addition  to  the  sanative  measures  already 
in  operation,  the  Commission  are  convinced  that  the  prevalence 
of  the  disease  will  be  greatly  circumscribed,  its  mortality  dimi- 
nished, and  the  public  guarded  against  panic  and  alarm,  the  great 
sources  of  danger — and,  under  the  blessing  of  Divine  Providence, 
the  pestilence  will  be  shorn  of  its  terrors,  and  mitigated  in  its  de- 
structive fury. 

SAMUEL  JACKSON, 
CHAS,  D.  MEIGS, 
RICHARD  HARLAN. 
July  8thy  1832. 


